**Clinical Question**
Does PSA-based screening reduce the mortality from prostate cancer in men aged 50-74 years?

**Bottom Line**
PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis.

**Major Points**


**Guidelines**


**Design**
- Multicenter, randomized control trial
- N=182,000 men (ages 50-74) identified through registries in seven European countries
- Intervention: Offered PSA screening every 4 years; control: No screening
- Core age group: 162,243 men (ages 55-69 years)
- Median follow-up: 9 years
- Primary outcome: Rate of death from prostate cancer, with follow-up ending December 31, 2006

**Population**
- Inclusion Criteria: Men ages 50 to 74 years
- Exclusion Criteria: Men with diagnosed prostate cancer
- Baseline Characteristics: Mean age was 60.8 years

**Interventions**
- Screening group offered PSA tests average once every 4 years; various interventions like biopsies based on elevated PSA values

**Outcomes**
- Primary Outcome: Rate of death from prostate cancer
- 0.80 (95% CI, 0.65 to 0.98; adjusted P=0.04) rate ratio for death from prostate cancer in the screening group
- To prevent one death from prostate cancer, 1,410 men needed to be screened and 48 additional prostate cancer cases needed to be treated
- Secondary Outcomes: Not discussed in the provided abstract

**Criticisms**
- Overdiagnosis and subsequent treatment of indolent cancers that might not impact longevity or quality of life
- The significant number of men requiring screening and treatment to prevent one prostate cancer death, indicating overtreatment potential

**Funding**
- Funded by grants from Europe Against Cancer, European Union framework programs, agencies or health authorities of the participating countries, alongside unconditional grants from Beckman Coulter

**Further Reading**
- "Screening and Prostate-Cancer Mortality in a Randomized European Study", New England Journal of Medicine