Cancer detection in the European Randomised Study of Screening for Prostate Cancer (ERSPC)

To provide a comprehensive analysis regarding outcomes of repeated screening and detection of low-grade versus high-grade cancer from the European Randomised Study of Screening for Prostate Cancer (ERSPC).

This study analysed men aged 55-69 years at random across the ERSPC trial centres except France. Men in the screening arm were classified as ever-attenders (who attended at least one screening cycle) or non-attenders (who did not attend a specific screening cycle). Cancer detection rates (CDRs) were calculated by age group and centre across three screening cycles. A secondary analysis incorporated interval prostate cancer (PCa) cases-those diagnosed outside the screening protocol-among both ever-attenders and non-attenders. Incidence data from the control arm were included for comparison.

Based on screen-detected cases, CDRs were consistently higher for low-grade than for intermediate- and high-grade cases across all centres and screening cycles. Trends in CDRs for high-grade cases varied by centre: CDRs decreased from the first to the second cycle and increased again during the third cycle in most centres, whereas CDRs increased in Spain with each successive screening cycle.

The ERSPC data show a decreasing detection rate for low-grade cancer and substantial variation in the detection rate for intermediate- and high-grade cancer between centres across repeated screening rounds. Increasing interval and non-attender cancers indicate diminishing effectiveness of uniform screening schedules. These findings support personalised screening approaches and improved strategies to maintain participation.