Prostate Cancer Mortality in Men not Attending a Population-based Screening Program: The 'Good', the 'Bad', and the 'Ugly' After 20-yr Follow-up in the European Randomised study of Screening for Prostate Cancer
In brief
Prostate cancer death 23% lower in men who attended PSA screening
In the ERSPC trial, men who attended at least one PSA screening round had a cumulative prostate-cancer mortality of 1.0% versus 1.2% in the unscreened control group, a 23% relative reduction. By contrast, men who never attended screening experienced a 39% higher death rate than controls, underscoring the importance of participation in population screening programs.
- Journal
- European urology open science (Q1)
- Published
- 30 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Renée C A Leenen, Esmée F H Mulder, Sebastiaan Remmers, Ivo I de Vos, Kirsi Talala, Jonas Hugosson, et al.
- PMID
- 42571431
- DOI
- 10.1016/j.euros.2026.06.009
Why clinicians should know about it
- Picked for Urology (top studies of the week, 16 August 2026): Prostate cancer mortality in non‑screened men after 20‑yr follow‑up
- Picked for Epidemiology (paper of the day, 10 August 2026): Screening nonattendance vs prostate cancer mortality cohort
Abstract
BACKGROUND AND OBJECTIVE: Nonattendance can substantially decrease the effectiveness of existing and potential future population-based screening programmes for (prostate) cancer. We evaluated the long-term association between nonattendance and prostate cancer-specific mortality (PCSM) in the European Randomised Study of Screening for Prostate Cancer (ERSPC), with up to 20 yr of follow-up. METHODS: This secondary analysis included 161 380 men aged 55-69 yr randomised to receive invitations for Prostate-specific antigen-based (PSA)-based screening (n = 72 460, screening arm [SA]) or to the control arm (CA) (n = 88,920) across seven ERSPC centres. Within the SA, men were classified as screening never-attenders (no attendance at any screening round) or screening ever-attenders (attended at least one screening round). The primary endpoint was PCSM. Cumulative incidence of PCSM was calculated using competing risk analysis, accounting for death from other causes as a competing event. Poisson regression was used to estimate rate ratios (RR) of cumulative PCSM between three groups: screening never-attenders, ever-attenders, and CA. KEY FINDINGS AND LIMITATIONS: Of the 72 460 men in the SA, 12,401 (17%) were defined as never-attenders. At 20 yr, the cumulative PCSM was 1.4% (95% confidence interval [CI], 1.2-1.6) among never-attenders, 1.2% (95% CI, 1.2-1.3) in the CA, and 1.0% (95% CI, 0.9-1.0) in ever-attenders. For PCSM, we observed an RR of 1.39 (95% CI, 1.2-1.6; p < 0.001) for never-attenders compared to the CA, while for ever-attenders compared to the CA, we observed an RR of 0.77 (95% CI, 0.69-0.85; p < 0.001). Data on determinants of attendance are lacking. CONCLUSIONS AND CLINICAL IMPLICATIONS: Men randomised to the SA but who never attended had higher observed PCSM than men in the CA who were not offered screening. Conversely, men in the SA who attended screening had lower observed PCSM than men in the CA, with a larger observed difference than that reported in prior intention-to-screen analyses. Trial registration: ISRCTN49127736.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.