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

Objectives: 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). Materials and Methods: 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. Results: 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. Conclusion: 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.