Frånlund M, Månsson M, Godtman RA et al: Results from 22 years of followup in the göteborg randomized population-based prostate cancer screening trial. J Urol 2022; 208: 292.

Study Need and Importance

Results from randomized prostate cancer screening trials are inconsistent. The aim of the present study was to present very long followup data of the Göteborg 1 screening trial which started early before opportunistic prostate specific antigen (PSA) testing was peaking and with up to 20-year duration of the screening period.

What We Found

At 22 years of followup, the prostate cancer mortality was 29% lower in the group of men who were invited every second year for PSA testing (41% in those who attended at least once) compared to a noninvited control group, but the prostate cancer incidence was 42% higher. The number of men needed to invite was 221 and the number needed to diagnose was 9 to prevent 1 prostate cancer death. Among invited men a higher prostate cancer mortality was seen among those never attending the program and among those who started the program after age 60, and the prostate cancer mortality was high 10 years after termination of the program.

Limitations

Limitations mainly include the increasing rate of opportunistic PSA testing during the study period in the control group and nonparticipation in the screening group, diluting the “true” effects of a well-organized PSA screening program.

Interpretation for Patient Care

Regular PSA testing from age 50 significantly decreases the risk of dying from prostate cancer at the expense of a rather high risk of detecting small slow-growing cancers, of which many never will need treatment. If a man chooses to participate in a prostate cancer screening program he should start around age 50. Testing should be done at least every second year and should not stop at age 70 for all men.