The latest data from the European Randomized Study on Screening for Prostate Cancer (ERSPC) has confirmed its earlier findings that PSA screening significantly reduces deaths from prostate cancer but does not affect all-cause mortality.

In the ERSPC trial, 162,388 men from centres across Europe aged 55-69 years at recruitment, were randomised to PSA-based screening four yearly or assigned to a control group with no screening.

The data now show, at 11 years follow-up, an absolute risk reduction of 1.07 deaths per 1,000 men screened, compared with 0.71 at 9 years follow-up.

The number needed to be invited for screening (NNI) to prevent one death from prostate cancer decreased from 1,410 at 9 years to 936 at 11 years follow-up. Corresponding figures for the number needed to be detected (NND) to prevent one death from prostate cancer were 48 and 33 respectively.

The relative risk reduction remained fairly static at 21% after 11 years compared with 20% reported at 9 years follow-up. After adjustment for non-compliance, relative risk reduction was 29%.

However, despite the reduction seen in the rate of death from prostate cancer, screening had no effect on all-cause mortality.

The ERSPC is a high quality study that will continue to generate much needed data to fuel the prostate cancer screening argument. While the prostate cancer specific results appear very encouraging for advocates of screening, the lack of impact on all-cause mortality is clearly a major issue.

Further information is awaited from trials such as PIVOT, comparing the results for radical prostatectomy versus watchful waiting.

What is the takehome message for GPs? Clearly, while the data do not necessarily justify the introduction of a hugely expensive national screening programme, they do emphasise that the asymptomatic patient requesting a screening PSA should not be discouraged or refused, but after adequate counselling should be able to access this test within primary care.

Dr Jonathan Rees

• Schroder FH, Hugosson J, Roobol MJ et al. Prostate-Cancer mortality at 11 years of follow-up. N Eng J Med 2012;366:981-90