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Results of the three rounds of the Finnish Prostate Cancer Screening Trial—The incidence of advanced cancer is decreased by screening
Author(s) -
Kilpeläinen Tuomas P.,
Auvinen Anssi,
Määttänen Liisa,
Kujala Paula,
Ruutu Mirja,
Stenman UlfHåkan,
Tammela Teuvo L.J.
Publication year - 2010
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.25368
Subject(s) - medicine , incidence (geometry) , confidence interval , prostate cancer , population , prostate cancer screening , rate ratio , randomized controlled trial , cancer , prostate , cancer screening , gynecology , prostate specific antigen , physics , environmental health , optics
Screening for prostate cancer (PC) remains a controversial issue despite some new evidence on the mortality benefits of PC screening. We conducted a prospective, randomized screening trial in Finland to investigate whether screening decreases PC incidence. Here, we report the incidence results from three screening rounds during a 12‐year period. Of the 80,144 men enrolled, 31,866 men were randomized to the screening arm (SA) and invited for screening with prostate‐specific antigen test (cut‐off 4.0 ng/ml) every 4 years, while the remaining men formed the control arm (CA) that received no interventions. The mean follow‐up time for PC incidence in both arms was over 9 years. The incidence rate of PC (including screen‐detected and interval cancers as well as cases among nonparticipants) was 9.1 per 1,000 person‐years in the SA and 6.2 in the CA, yielding an incidence rate ratio (IRR) 1.5 (95% confidence interval 1.4–1.5). The incidence of advanced PC was 1.1 in the SA and 1.5 in the CA, IRR = 0.7 (0.6–0.8) and the difference emerges after 5–6 years of follow‐up. The incidence of localized PC was 7.5 in the SA and 4.6 in the CA, IRR = 1.6 (1.5–1.7). The results from our large population‐based trial indicate that screening for PC decreases the incidence of advanced PC. When compared with the CA, the PC detected in the SA there were substantially more often localized, low‐grade PCs due to overdiagnosis.