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Different Effects of Screening on Prostate Cancer Death in Two Trials

What is the problem and what is known about it so far? Prostate cancer occurs frequently, and the screening test does a good job of identifying men with the disease. Some cancer cases respond well to treatment, but others do not need treatment because the cancer does not respond or because it grows very slowly. It is difficult to separate cancer that responds from other cancer, so it is difficult to know when to treat and when not to treat. In this situation, screening involves tradeoffs. If screening is not done, more men will fail to get treatment that might prevent premature death because their cancer will go undetected until after it has spread. If screening is done, more men will get treatment that cannot help them, and some of them will have lower quality of life due to the treatment. Why did the researchers do this particular study? Two clinical trialsone in Europe and the other in the United Statesprovide the best information about whether screening lowers the risk for death due to prostate cancer. The European study found that men who were invited to be screened had fewer prostate cancer deaths than men who were not invited, but the American study found similar numbers of prostate cancer deaths in the 2 groups. The researchers of the current study wanted to figure out whether the results of the 2 trials were as different as they seemed. Who was studied? Both trials studied men aged 55 years or older, and both randomly invited some men to be screened but not others. How was the study done? In the 2 original studies, some men who were invited to be screened did not get screened, and some men who were not invited were screened anyway. These studies used traditional methods to compare the risk for death due to prostate cancer in men invited to have screening with the risk for death in men who were not invited to have screening. In contrast, the current study used a different approach to examine how the actual amount of screening in each groupregardless of whether men were invited to have screeningaffected the risk for death due to prostate cancer. What did the researchers find? The 2 trials had remarkably similar results when the amount of screening actually received in each group was accounted for. Screening lowered the risk for prostate cancer death by 25% to 32% in men who were invited to have screening in the 2 trials compared with those who were not screened. What were the limitations of the study? The researchers used a simplified summary measure of how much screening was actually received in each trial group. What are the implications of the study? The European and American trials agree that screening lowers the risk for death due to prostate cancer compared with no screening.