{"product_id":"single-psa-screening-invitation-and-15-year-prostate-cancer-mortality-results-from-the-cap-trial","title":"Single PSA Screening Invitation and 15-Year Prostate Cancer Mortality: Results from the CAP Trial","description":"\u003cp\u003eIn a large UK trial of 415,357 men aged 50–69, a single invitation for a prostate-specific antigen (PSA) screening test reduced deaths from prostate cancer at 15 years. This reduction was compared with no invitation (0.69% vs 0.78%; rate ratio 0.92; 95% CI 0.85–0.99; p=0.03). The absolute benefit was small — about 0.09% fewer deaths — and there was no difference in overall survival (23.2% vs 23.3% all-cause deaths; RR 0.97; 95% CI 0.94–1.01; p=0.11). Screening increased detection of low-grade and localized cancers but not high-grade or advanced disease, and over-diagnosis remained a concern.\u003c\/p\u003e\n\n\u003ch1\u003eSingle PSA Screening Invitation and 15-Year Prostate Cancer Mortality: Results from the CAP Trial\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Why This Research Matters\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#methods\"\u003eHow the Study Was Conducted\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#participants\"\u003eWho Took Part\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#intervention\"\u003eWhat the Screening Invitation Involved\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#outcomes\"\u003eWhat the Researchers Measured\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#results\"\u003eKey Findings: Prostate Cancer Deaths\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#survival\"\u003eOverall Survival\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#grade\"\u003eCancer Grade and Stage at Diagnosis\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#diagnosis\"\u003eProstate Cancer Diagnosis Rates Over Time\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#subgroups\"\u003eSubgroup and Exploratory Findings\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#adverse\"\u003eAdverse Events\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#implications\"\u003eWhat This Means for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations of the Study\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eIn a UK trial of 415,357 men aged 50–69, a single PSA screening invitation reduced prostate cancer deaths at 15 years by about 9 per 10,000 men invited.\u003c\/li\u003e\n\u003cli\u003eThe trial found no significant difference in overall survival between men invited for PSA screening and those not invited.\u003c\/li\u003e\n\u003cli\u003eScreening increased detection of low-grade and localized prostate cancers but not high-grade or advanced disease.\u003c\/li\u003e\n\u003cli\u003eOver-diagnosis was estimated at 9.2% for men aged 50–54 and 20.8% for men aged 65–69 in the trial.\u003c\/li\u003e\n\u003cli\u003eHarms of PSA screening include over-diagnosis, biopsy complications, and treatment side effects on urinary, sexual, and bowel function.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: Why This Research Matters\u003c\/h2\u003e\n\u003cp\u003eProstate cancer is one of the most commonly diagnosed cancers in men. In England, the number of men diagnosed with prostate cancer increased by 68% between 2001 and 2019, rising from 28,216 to 47,479 cases. This rise reflects both an aging population and increased use of PSA testing.\u003c\/p\u003e\n\n\u003cp\u003eIn the United States, approximately 3.3 million men currently live with a prostate cancer diagnosis. While low-risk prostate cancer grows slowly and carries a low risk of death, aggressive prostate cancer causes approximately 12,000 deaths in the UK and 34,700 deaths in the U.S. each year.\u003c\/p\u003e\n\n\u003cp\u003eThe goal of PSA screening is to find curable cancer early and thereby reduce deaths. However, uncertainty has remained about whether PSA screening actually lowers long-term mortality. The CAP trial was designed to help answer this question.\u003c\/p\u003e\n\n\u003cp\u003eThe CAP randomized clinical trial previously reported that at a median of 10 years, a single invitation for PSA screening did not reduce prostate cancer mortality. This finding was compared with a control group (0.29% vs 0.30%; rate ratio 0.96; 95% CI 0.85–1.08; p=0.5). The current report describes the pre-specified secondary outcome of prostate cancer mortality at 15-year follow-up.\u003c\/p\u003e\n\n\u003ch2 id=\"methods\"\u003eHow the Study Was Conducted\u003c\/h2\u003e\n\u003cp\u003eThe CAP trial was a cluster randomized clinical trial conducted in England and Wales. In this design, entire primary-care practices — rather than individual men — were randomly assigned to either the screening invitation group or the control group.\u003c\/p\u003e\n\n\u003cp\u003eBetween 2001 and 2007, 785 eligible general practices across eight hospital catchment areas (Birmingham, Bristol, Cambridge, Cardiff, Leeds, Leicester, Newcastle, and Sheffield) were randomized. Randomization used a computerized random number generator and was stratified within groups of 10–12 neighboring practices.\u003c\/p\u003e\n\n\u003cp\u003eBecause allocation happened before practices were invited to take part, it was not possible to conceal which group each practice was assigned to. Of the eligible practices, 573 (73%) agreed to participate — 68% of those randomized to the intervention group and 78% of those randomized to the control group.\u003c\/p\u003e\n\n\u003cp\u003eMen were enrolled between January 8, 2002, and January 20, 2009. Final follow-up was completed on March 31, 2021. The Derby National Research Ethics Service Committee East Midlands approved the study.\u003c\/p\u003e\n\n\u003cp\u003eMen who attended PSA testing in the intervention group gave individual written informed consent. For men in the control group and non-responders in the intervention group, individual consent was not sought. Instead, approval for identification and linkage to routine electronic records was obtained under Section 251 of the NHS Act 2006.\u003c\/p\u003e\n\n\u003cp\u003eProstate cancer deaths were identified using death certificates from the Office for National Statistics and were reviewed by an independent Cause of Death Evaluation committee. Cancer stage and Gleason grade were obtained from the National Disease Registration Service.\u003c\/p\u003e\n\n\u003cp\u003eStatistical analysis used random-effects Poisson regression to estimate rate ratios, accounting for clustering within GP practices. Follow-up for each participant was divided into five-year age groups. Results were considered statistically significant if the p-value was less than 0.05.\u003c\/p\u003e\n\n\u003ch2 id=\"participants\"\u003eWho Took Part\u003c\/h2\u003e\n\u003cp\u003eThe study included 415,357 men aged 50–69 years registered with participating general practices. The mean age was 59.0 years (standard deviation 5.6 years).\u003c\/p\u003e\n\n\u003cp\u003eMen were assigned to two groups:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eIntervention group:\u003c\/strong\u003e 195,912 men invited for PSA screening\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eControl group:\u003c\/strong\u003e 219,445 men who received standard care without a screening invitation\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFollow-up data for cancer diagnosis and mortality at a median of 15 years were available for 408,721 men (98% of those eligible). This included 189,326 men (97%) in the intervention group and 219,395 men (more than 99%) in the control group.\u003c\/p\u003e\n\n\u003cp\u003eBaseline characteristics were similar between the two groups at both the practice level and the individual level. Men with prostate cancer diagnosed on or before the randomization date were excluded, as were men registered with practices on a temporary or emergency basis.\u003c\/p\u003e\n\n\u003ch2 id=\"intervention\"\u003eWhat the Screening Invitation Involved\u003c\/h2\u003e\n\u003cp\u003eMen in the intervention group received a single invitation for a PSA test after counseling. If the PSA result was between 3.0 and 19.9 ng\/ml, they were offered a 10-core transrectal ultrasound-guided biopsy.\u003c\/p\u003e\n\n\u003cp\u003eAll laboratories participated in the UK National External Quality Assessment Service for PSA testing. Test results that did not meet quality assurance requirements, were lost, or came from ambiguous consent or insufficient blood samples were considered non-valid.\u003c\/p\u003e\n\n\u003cp\u003eMen in the intervention group who were diagnosed with localized prostate cancer were invited to join a second randomized trial called ProtecT. That trial randomly assigned participants to active monitoring (regular PSA testing and clinical review), radical prostatectomy (surgical removal of the prostate), or radical conformal radiotherapy with hormone treatment.\u003c\/p\u003e\n\n\u003cp\u003eMen with a PSA of 20 ng\/ml or higher were referred to a urologist and received standard care.\u003c\/p\u003e\n\n\u003cp\u003eMen in the control group received standard NHS management but no formal invitation for PSA testing as part of this study. Based on analysis of a national primary care database, cumulative PSA testing for prostate cancer detection in the control group was estimated at 10% to 15% over 10 years of median follow-up.\u003c\/p\u003e\n\n\u003cp\u003eAmong men in the intervention group, 75,694 (40%) underwent PSA testing, and 64,425 (34%) had a valid test result. Of those with valid results, 6,855 (11%) had a PSA value between 3 and 19.9 ng\/ml and were eligible for the ProtecT trial. Of these, 5,848 (85%) had a prostate biopsy.\u003c\/p\u003e\n\n\u003ch2 id=\"outcomes\"\u003eWhat the Researchers Measured\u003c\/h2\u003e\n\u003cp\u003eThe primary outcome of the CAP trial — prostate cancer mortality at 10 years — was reported previously. This report covers the remaining pre-specified secondary outcomes at 15-year follow-up:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eDefinite or probable prostate cancer mortality at 15 years\u003c\/li\u003e\n  \u003cli\u003eAll-cause mortality at 15 years\u003c\/li\u003e\n  \u003cli\u003eProstate cancer grade and stage at diagnosis at 15 years\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eOther secondary outcomes reported earlier included all-cause mortality at 10 years, disease grade and stage at 10 years, cost-effectiveness, and health-related quality of life.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers also conducted exploratory analyses. These included a sensitivity analysis that re-defined the primary outcome to include definite, probable, possible, and treatment-related prostate cancer deaths. They also estimated mean sojourn time — the period during which a tumor is asymptomatic but detectable by screening — and over-diagnosis rates.\u003c\/p\u003e\n\n\u003ch2 id=\"results\"\u003eKey Findings: Prostate Cancer Deaths\u003c\/h2\u003e\n\u003cp\u003eAfter a median follow-up of 15.4 years (interquartile range 14.2–16.4 years; range 12.2–19.2 years), 1,199 men (0.69%) in the intervention group and 1,451 men (0.78%) in the control group died of prostate cancer.\u003c\/p\u003e\n\n\u003cp\u003eThe rate of prostate cancer death was 0.47 per 1,000 person-years in the intervention group and 0.50 per 1,000 person-years in the control group. The rate ratio was 0.92 (95% CI 0.85–0.99; p=0.03), meaning the screening invitation was associated with an 8% relative reduction in the rate of prostate cancer death.\u003c\/p\u003e\n\n\u003cp\u003eThe absolute reduction in prostate cancer deaths was 0.09% (risk difference −0.09%; 95% CI −0.15 to −0.03; p=0.02). In plain terms, this means that about 9 fewer men out of every 10,000 invited for screening died of prostate cancer over 15 years.\u003c\/p\u003e\n\n\u003cp\u003eAn instrumental variable analysis estimated the effect of actually attending the PSA screening clinic. Among men who attended, the prostate cancer mortality rate ratio was 0.83 (95% CI 0.68–1.00; p=0.053). This result was at the borderline of statistical significance.\u003c\/p\u003e\n\n\u003ch2 id=\"survival\"\u003eOverall Survival\u003c\/h2\u003e\n\u003cp\u003eThere was no statistically significant difference in overall survival between the two groups. There were 45,084 deaths (23.2%) in the intervention group and 50,336 deaths (23.3%) in the control group.\u003c\/p\u003e\n\n\u003cp\u003eThe rate ratio for all-cause mortality was 0.97 (95% CI 0.94–1.01; p=0.11). This means the difference in overall deaths between the groups could have been due to chance. Other causes of death were similar between the two groups.\u003c\/p\u003e\n\n\u003ch2 id=\"grade\"\u003eCancer Grade and Stage at Diagnosis\u003c\/h2\u003e\n\u003cp\u003eScreening changed the types of prostate cancers that were detected. Compared with the control group, men in the intervention group were more likely to be diagnosed with low-grade and localized cancers. Men in the intervention group were less likely to be diagnosed with high-grade or advanced cancers.\u003c\/p\u003e\n\n\u003cp\u003eSpecific findings over the 15-year follow-up:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLow-grade cancer (Gleason score 6 or less):\u003c\/strong\u003e 2.2% of men in the intervention group vs 1.6% in the control group (risk difference 0.58%; 95% CI 0.50%–0.67%)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eHigh-grade cancer (Gleason score 8 or higher):\u003c\/strong\u003e 1.2% vs 1.3% (risk difference −0.15%; 95% CI −0.22% to −0.08%)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLocalized cancer (stage T1\/T2):\u003c\/strong\u003e 3.6% vs 3.1% (risk difference 0.56%; 95% CI 0.44%–0.67%)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAdvanced-stage cancer (T4\/N1\/M1):\u003c\/strong\u003e 0.9% vs 1.1% (risk difference −0.16%; 95% CI −0.22% to −0.10%)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe trend across cancer grades and stages was statistically significant (p for trend less than 0.001 for both). There was no significant difference between groups in intermediate-grade (Gleason score 7), locally-advanced (stage T3), or distally-advanced tumors.\u003c\/p\u003e\n\n\u003cp\u003eMen in the intervention group were diagnosed at a mean age 1.22 years younger than men in the control group (95% CI 1.02–1.42; p\u0026lt;0.001).\u003c\/p\u003e\n\n\u003ch2 id=\"diagnosis\"\u003eProstate Cancer Diagnosis Rates Over Time\u003c\/h2\u003e\n\u003cp\u003eOver the full 15-year follow-up, 12,013 men (4.88 per 1,000 person-years; cumulative risk 7.1%) were diagnosed with prostate cancer in the intervention group, compared with 12,958 men (4.60 per 1,000 person-years; cumulative risk 6.9%) in the control group.\u003c\/p\u003e\n\n\u003cp\u003eThe difference in diagnosis rates between the groups changed markedly over time. The cumulative risk difference per 1,000 men was:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e12.23 (95% CI 11.63–12.84) at 18 months\u003c\/li\u003e\n  \u003cli\u003e4.80 (95% CI 3.53–6.07) at 10 years\u003c\/li\u003e\n  \u003cli\u003e1.38 (95% CI −0.38 to 3.14) at 15 years\u003c\/li\u003e\n  \u003cli\u003e0.86 (95% CI −1.80 to 3.53) at 18 years\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThis means screening caused a large spike in diagnoses early on, but the difference between groups narrowed over time as cancers were also detected in the control group.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers also estimated mean sojourn time and over-diagnosis rates. For men aged 50–54, the mean sojourn time was 12.1 years and over-diagnosis was 9.2%. For men aged 65–69, the mean sojourn time was 15.3 years and over-diagnosis was 20.8%.\u003c\/p\u003e\n\n\u003ch2 id=\"subgroups\"\u003eSubgroup and Exploratory Findings\u003c\/h2\u003e\n\u003cp\u003eThe mortality results were similar when the researchers included prostate cancer deaths judged as \"possible\" by the Cause of Death Evaluation committee. The results were also similar when they restricted the analysis to deaths judged as \"definite\" prostate cancer deaths.\u003c\/p\u003e\n\n\u003cp\u003eThere was little evidence that the effect of screening differed by age group or socioeconomic status. The p-values for interaction were 0.46 or higher, meaning no statistically significant differences were found across these subgroups.\u003c\/p\u003e\n\n\u003ch2 id=\"adverse\"\u003eAdverse Events\u003c\/h2\u003e\n\u003cp\u003eAmong the deaths due to prostate cancer, 8 deaths (0.7%) in the intervention group and 7 deaths (0.5%) in the control group were related to a diagnostic biopsy or prostate cancer treatment. Other adverse events were reported in previous publications.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eWhat This Means for Patients\u003c\/h2\u003e\n\u003cp\u003eThis trial found that a single invitation for PSA screening reduced prostate cancer deaths at 15 years, but the absolute benefit was small. The reduction was 0.09% — about 9 fewer deaths per 10,000 men invited.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers noted that this reduction was smaller than the effect size they had defined in advance as important for clinical and public health benefit. There was no effect on overall survival.\u003c\/p\u003e\n\n\u003cp\u003eThe harms of PSA testing include over-diagnosis (finding cancers that would never have caused symptoms), biopsy complications, and adverse treatment effects on urinary, sexual, and bowel function. There is also the potential to miss an aggressive prostate cancer.\u003c\/p\u003e\n\n\u003cp\u003eThe CAP trial's single-invitation approach was designed to minimize over-diagnosis and over-treatment compared with other screening trials. However, over-diagnosis was still observed after 15 years of median follow-up.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers emphasized that policy-makers considering prostate cancer screening should weigh this small reduction in deaths against the potential adverse effects associated with over-diagnosis and over-treatment.\u003c\/p\u003e\n\n\u003cp\u003eThe European Randomized Study of Prostate Cancer Screening (ERSPC) enrolled 162,243 men across 7 centers. ERSPC reported that PSA screening conducted every 2–4 years (a mean of 1.4 tests per participant) reduced prostate cancer mortality. The CAP trial used a different approach with only a single invitation.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations of the Study\u003c\/h2\u003e\n\u003cp\u003eThe study had several limitations that patients should understand.\u003c\/p\u003e\n\n\u003cp\u003eFirst, the absolute reduction in prostate cancer deaths was very small. The number of men who would need to be invited for screening to prevent one prostate cancer death is large.\u003c\/p\u003e\n\n\u003cp\u003eSecond, there was no improvement in overall survival. This means that even though fewer men died of prostate cancer in the screening group, the total number of deaths was not significantly different between the groups.\u003c\/p\u003e\n\n\u003cp\u003eThird, the trial used a single invitation for PSA screening rather than a repeated screening program. This design may not reflect how PSA screening is typically performed in practice, where men may be tested multiple times over many years.\u003c\/p\u003e\n\n\u003cp\u003eFourth, some men in the control group did undergo PSA testing outside the trial. An estimated 10% to 15% of control-group men had PSA testing over 10 years. This could reduce the apparent difference between the two groups.\u003c\/p\u003e\n\n\u003cp\u003eFifth, the study did not adjust p-values for multiple comparisons. The researchers explained that conventional adjustments assume statistical independence between estimates, which was not the case for analyses of the same outcome at 10 and 15 years.\u003c\/p\u003e\n\n\u003cp\u003eSixth, some data were missing. Among men who developed prostate cancer in the intervention group, 9.4% were missing cancer stage data and 10.4% were missing Gleason grade data. In the control group, 7.8% were missing stage data and 11.2% were missing grade data.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations\u003c\/h2\u003e\n\u003cp\u003eBased on this study, men and their doctors should consider the following points when deciding about PSA screening:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eUnderstand the small absolute benefit.\u003c\/strong\u003e A single PSA screening invitation reduced prostate cancer deaths by about 9 per 10,000 men over 15 years. This is a real but modest benefit.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eConsider the risks of over-diagnosis.\u003c\/strong\u003e Screening finds many low-grade, slow-growing cancers that may never have caused harm. Over-diagnosis rates ranged from 9.2% in men aged 50–54 to 20.8% in men aged 65–69.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDiscuss the potential harms.\u003c\/strong\u003e These include biopsy complications and treatment side effects affecting urinary, sexual, and bowel function.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eRecognize that overall survival was not improved.\u003c\/strong\u003e The study found no significant difference in deaths from any cause between screened and unscreened men.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eTalk with your doctor about your individual risk.\u003c\/strong\u003e The decision to undergo PSA testing should be personalized, taking into account your age, family history, and overall health.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBe aware that this study used a single screening invitation.\u003c\/strong\u003e Other screening approaches, such as repeated testing every 2–4 years, may have different benefits and harms.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eThe researchers concluded that policy-makers should consider this small reduction in prostate cancer deaths. Policy-makers should weigh this reduction against the potential adverse effects of over-diagnosis and over-treatment when making decisions about prostate cancer screening programs.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWho was invited for PSA screening in this trial?\u003c\/h3\u003e\n\u003cp\u003eIn a UK trial, 415,357 men aged 50 to 69 registered with participating general practices were assigned to two groups. One group of 195,912 men received a single invitation for a PSA test after counseling. The other group of 219,445 men received standard care without a screening invitation. Men already diagnosed with prostate cancer were excluded.\u003c\/p\u003e\n\u003ch3\u003eWhat did the screening invitation involve?\u003c\/h3\u003e\n\u003cp\u003eMen in the invitation group had a single PSA test after counseling. If the result was between 3.0 and 19.9 ng\/ml, they were offered a 10-core transrectal ultrasound-guided biopsy. Men with a PSA of 20 ng\/ml or higher were referred to a urologist for standard care. Men diagnosed with localized cancer were invited to join a separate treatment trial.\u003c\/p\u003e\n\u003ch3\u003eHow much did a single PSA screening invitation reduce prostate cancer deaths?\u003c\/h3\u003e\n\u003cp\u003eAfter a median follow-up of 15.4 years, 0.69% of men in the invitation group died of prostate cancer versus 0.78% in the control group. This was an 8% relative reduction and an absolute reduction of 0.09%, meaning about 9 fewer deaths per 10,000 men invited. The benefit was small.\u003c\/p\u003e\n\u003ch3\u003eDid the screening invitation improve overall survival?\u003c\/h3\u003e\n\u003cp\u003eNo. In the trial, 23.2% of men in the invitation group died from any cause compared with 23.3% in the control group. The rate ratio was 0.97, and the difference was not statistically significant. This means the difference in overall deaths between the groups could have been due to chance.\u003c\/p\u003e\n\u003ch3\u003eWhat are the risks of PSA screening?\u003c\/h3\u003e\n\u003cp\u003eThe harms include over-diagnosis, which means finding cancers that would never have caused symptoms, biopsy complications, and treatment side effects affecting urinary, sexual, and bowel function. In the trial, over-diagnosis was estimated at 9.2% for men aged 50 to 54 and 20.8% for men aged 65 to 69.\u003c\/p\u003e\n\u003ch3\u003eWhat does over-diagnosis mean in this trial?\u003c\/h3\u003e\n\u003cp\u003eOver-diagnosis means detecting a prostate cancer that would never have caused symptoms or death during a man's lifetime. In the trial, over-diagnosis was estimated at 9.2% for men aged 50 to 54 and 20.8% for men aged 65 to 69. Screening increased detection of low-grade, localized cancers but not high-grade or advanced disease.\u003c\/p\u003e\n\u003ch3\u003eShould I have a PSA test?\u003c\/h3\u003e\n\u003cp\u003eThe decision should be personalized with your doctor, considering your age, family history, and overall health. In the trial, a single PSA screening invitation reduced prostate cancer deaths by about 9 per 10,000 men over 15 years, but overall survival was not improved. Discuss the small absolute benefit and the risks of over-diagnosis and treatment side effects.\u003c\/p\u003e\n\u003ch3\u003eShould I get a second opinion before deciding about PSA screening after a single invitation?\u003c\/h3\u003e\n\u003cp\u003eA single PSA screening invitation reduced prostate cancer deaths by about 9 per 10,000 men over 15 years, with no difference in overall survival, and over-diagnosis ranged from 9.2% in men aged 50–54 to 20.8% in men aged 65–69. Because the decision depends on age, family history, and overall health, and because repeated testing every 2–4 years may carry different benefits and harms, a second opinion can help clarify whether screening or biopsy is appropriate for you. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e Prostate-Specific Antigen Screening and 15-Year Prostate Cancer Mortality\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Richard Michael Martin, Emma L. Turner, Grace Young, Chris D. Metcalfe, Eleanor I. Walsh, J. Athene Lane, et al.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eLead institution:\u003c\/strong\u003e Bristol Medical School, Department of Population Health Sciences, University of Bristol, Bristol, UK\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c\/strong\u003e ISRCTN92187251\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eNote:\u003c\/strong\u003e This patient-friendly article is based on peer-reviewed research. The original article was published in a peer-reviewed medical journal. Patients should discuss any questions about prostate cancer screening with their healthcare provider.\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47816845033628,"sku":null,"price":0.0,"currency_code":"KRW","in_stock":true}],"url":"https:\/\/diagnosticdetectives.kr\/products\/single-psa-screening-invitation-and-15-year-prostate-cancer-mortality-results-from-the-cap-trial","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}