***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: INTRODUCTION Mass screening modalities remained controversial and made necessary large studies . The European R and omized study of Screening for Prostate cancer ( ERSPC ) was initiated in 1994 . Eight countries including France are participating . METHODS ERSPC is a multicentric r and omised study and started with the aim to determine whether a 20 % reduction in prostate cancer mortality can be achieved with PSA-based screening .  Men aged 50 - 74 and living in the Tarn or Hérault were included . After r and omization and exclusion of men who died or had a prostate cancer were invited to participate by giving their consent and had a PSA test . In case of PSA greater than or equal to 3 ng/ml , biopsy was recommended . Included men in both screening and control group were followed through cancer registries . Objective was to present first round results of French participation to ERSPC , to determine factors of participation and to compare detected cancers cases between both groups . RESULTS Population of men included was 84,781 and were r and omized in screening ( n=42,590 ) or control ( n=42,191 ) group .  Participation rate was 36.9 % in Tarn and 24.3 % in Hérault . PSA was greater than or equal to 3 ng/ml in 15,4 % of cases ( n=1812 ) and 45.9 % of men ( n=832 ) who were biopsied . Age , previous PSA performed within two years prior to invitation , health insurance and department of residence were significantly associated to participation rate . Cumulated incidence with a four years follow-up was 2.48 % ( n=1053 ) in screening and 1.99 % ( n=840 ) in control group , with a relative risk ( RR ) of 1.242 . Corresponding RR for Tarn and Hérault were 1.37 and 1.20 respectively . Clinical parameters and treatments modalities were similar between both screening and control groups ( radical prostatectomy 68 % and radiation therapy 20 % ) . CONCLUSION Participation rate at first round was modest . Profile of men who participated compared to men who did not were different . The control group was probably contaminated by PSA testing outside study protocol . Consequences at ERSPC level of this low participation rate on final analysis remain to be determined The objectives of the Prostate , Lung , Colorectal and Ovarian Cancer Screening Trial are to determine in screenees ages 55 - 74 at entry whether screening with flexible sigmoidoscopy ( 60-cm sigmoidoscope ) can reduce mortality from colorectal cancer , whether screening with chest X-ray can reduce mortality from lung cancer , whether screening men with digital rectal examination ( DRE ) plus serum prostate-specific antigen ( PSA ) can reduce mortality from prostate cancer , and whether screening women with CA125 and transvaginal ultrasound ( TVU ) can reduce mortality from ovarian cancer . Secondary objectives are to assess screening variables other than mortality for each of the interventions including sensitivity , specificity , and positive predictive value ; to assess incidence , stage , and survival of cancer cases ; and to investigate biologic and /or prognostic characterizations of tumor tissue and biochemical products as intermediate endpoints . The design is a multicenter , two-armed , r and omized trial with 37,000 females and 37,000 males in each of the two arms . In the intervention arm , the  PSA and CA125 tests  are performed at entry , then annually for 5 years . The  DRE , TVU , and chest X-ray exams  are performed at entry and then annually for 3 years . Sigmoidoscopy is performed at entry and then at the 5-year point . Participants in the control arm follow their usual medical care practice s. Participants will be followed for at least 13 years from r and omization to ascertain all cancers of the prostate , lung , colorectum , and ovary , as well as deaths from all causes . A pilot phase was undertaken to assess the r and omization , screening , and data collection procedures of the trial and to estimate design parameters such as compliance and contamination levels . This paper describes eligibility , consent , and other design features of the trial , r and omization and screening procedures , and an outline of the follow-up procedures . Sample -size calculations are reported , and a data analysis plan is presented BACKGROUND The European R and omized Study of Screening for Prostate Cancer was initiated in the early 1990s to evaluate the effect of screening with prostate-specific-antigen ( PSA ) testing on death rates from prostate cancer . METHODS We identified 182,000 men between the ages of 50 and 74 years through registries in seven European countries for inclusion in our study . The men were r and omly assigned to a group that was offered PSA screening at an average of once every 4 years or to a control group that did not receive such screening . The predefined core age group for this study included 162,243 men between the ages of 55 and 69 years . The primary outcome was the rate of death from prostate cancer . Mortality follow-up was identical for the two study groups and ended on December 31 , 2006 . RESULTS In the screening group , 82 % of men accepted at least one offer of screening . During a median follow-up of 9 years , the cumulative incidence of prostate cancer was 8.2 % in the screening group and 4.8 % in the control group . The rate ratio for death from prostate cancer in the screening group , as compared with the control group , was 0.80 ( 95 % confidence interval [ CI ] , 0.65 to 0.98 ; adjusted P=0.04 ) . The absolute risk difference was 0.71 death per 1000 men . This means that 1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent one death from prostate cancer . The analysis of men who were actually screened during the first round ( excluding subjects with noncompliance ) provided a rate ratio for death from prostate cancer of 0.73 ( 95 % CI , 0.56 to 0.90 ) . CONCLUSIONS PSA-based screening reduced the rate of death from prostate cancer by 20 % but was associated with a high risk of overdiagnosis . ( Current Controlled Trials number , IS RCT N49127736 . BACKGROUND Prostate cancer is one of the leading causes of death from malignant disease among men in the developed world . One strategy to decrease the risk of death from this disease is screening with prostate-specific antigen ( PSA ) ; however , the extent of benefit and harm with such screening is under continuous debate . METHODS In December , 1994 , 20,000 men born between 1930 and 1944 , r and omly sample d from the population register , were r and omised by computer in a 1:1 ratio to either a screening group invited for PSA testing every 2 years ( n=10,000 ) or to a control group not invited ( n=10,000 ) . Men in the screening group were invited up to the upper age limit ( median 69 , range 67 - 71 years ) and only men with raised PSA concentrations were offered additional tests such as digital rectal examination and prostate biopsies . The primary endpoint was prostate-cancer specific mortality , analysed according to the intention-to-screen principle . The study is ongoing , with men who have not reached the upper age limit invited for PSA testing . This is the first planned report on cumulative prostate-cancer incidence and mortality calculated up to Dec 31 , 2008 . This study is registered as an International St and ard R and omised Controlled Trial IS RCT N54449243 . FINDINGS In each group , 48 men were excluded from the analysis because of death or emigration before the r and omisation date , or prevalent prostate cancer . In men r and omised to screening , 7578 ( 76 % ) of 9952 attended at least once . During a median follow-up of 14 years , 1138 men in the screening group and 718 in the control group  were diagnosed with prostate cancer , result ing in a cumulative prostate-cancer incidence of 12.7 % in the screening group and 8.2 % in the  control  group ( hazard ratio 1.64 ; 95 % CI 1.50 - 1.80 ; p<0.0001 ) . The absolute cumulative risk reduction of death from prostate cancer at 14 years was 0.40 % ( 95 % CI 0.17 - 0.64 ) , from 0.90 % in the control group to 0.50 % in the screening group . The rate ratio for death from prostate cancer was 0.56 ( 95 % CI 0.39 - 0.82 ; p=0.002 ) in the screening compared with the control group . The rate ratio of death from prostate cancer for attendees compared with the control group was 0.44 ( 95 % CI 0.28 - 0.68 ; p=0.0002 ) . Overall , 293 ( 95 % CI 177 - 799 ) men needed to be invited for screening and 12 to be diagnosed to prevent one prostate cancer death . INTERPRETATION This study shows that prostate cancer mortality was reduced almost by half over 14 years . However , the risk of over-diagnosis is substantial and the number needed to treat is at least as high as in breast-cancer screening programmes . The benefit of prostate-cancer screening compares favourably to other cancer screening programs . FUNDING The Swedish Cancer Society , the Swedish Research Council , and the National Cancer Institute BACKGROUND The effect of screening with prostate-specific-antigen ( PSA ) testing and digital rectal examination on the rate of death from prostate cancer is unknown . This is the first report from the Prostate , Lung , Colorectal , and Ovarian ( PLCO ) Cancer Screening Trial on prostate-cancer mortality . METHODS From 1993 through 2001 , we r and omly assigned 76,693 men at 10 U.S. study centers to receive either annual screening ( 38,343 subjects ) or usual care as the control ( 38,350 subjects ) . Men in the screening group were offered annual PSA testing for 6 years and digital rectal examination for 4 years . The subjects and health care providers received the results and decided on the type of follow-up evaluation . Usual care sometimes included screening , as some organizations have recommended . The numbers of all cancers and deaths and causes of death were ascertained . RESULTS In the screening group , rates of compliance were 85 % for PSA testing and 86 % for digital rectal examination . Rates of screening in the control group increased from 40 % in the first year to 52 % in the sixth year for PSA testing and ranged from 41 to 46 % for digital rectal examination . After 7 years of follow-up , the incidence of prostate cancer per 10,000 person-years was 116 ( 2820 cancers ) in the screening group and 95 ( 2322 cancers ) in the control group ( rate ratio , 1.22 ; 95 % confidence interval [ CI ] , 1.16 to 1.29 ) . The incidence of death per 10,000 person-years was 2.0 ( 50 deaths ) in the screening group and 1.7 ( 44 deaths ) in the control group ( rate ratio , 1.13 ; 95 % CI , 0.75 to 1.70 ) . The data at 10 years were 67 % complete and consistent with these overall findings . CONCLUSIONS After 7 to 10 years of follow-up , the rate of death from prostate cancer was very low and did not differ significantly between the two study groups . ( Clinical Trials.gov number , NCT00002540 . BACKGROUND The time by which prostate-specific antigen ( PSA ) screening advances prostate cancer diagnosis , called the lead time , has been reported by several studies , but results have varied widely , with mean lead times ranging from 3 to 12 years . A quantity that is closely linked with the lead time is the overdiagnosis frequency , which is the fraction of screen-detected cancers that would not have been diagnosed in the absence of screening . Reported overdiagnosis estimates have also been variable , ranging from 25 % to greater than 80 % of screen-detected cancers . METHODS We used three independently developed mathematical models of prostate cancer progression and detection that were calibrated to incidence data from the Surveillance , Epidemiology , and End Results program to estimate lead times and the fraction of overdiagnosed cancers due to PSA screening among US men aged 54 - 80 years in 1985 - 2000 . Lead times were estimated by use of three definitions . We also compared US and earlier estimates from the Rotterdam section of the European R and omized Study of Screening for Prostate Cancer ( ERSPC ) that were calculated by use of a microsimulation screening analysis ( MISCAN ) model . RESULTS The models yielded similar estimates for each definition of lead time , but estimates differed across definitions . Among screen-detected cancers that would have been diagnosed in the patients ' lifetimes , the estimated mean lead time ranged from 5.4 to 6.9 years across models , and overdiagnosis ranged from 23 % to 42 % of all screen-detected cancers . The original MISCAN model fitted to ERSPC Rotterdam data predicted a mean lead time of 7.9 years and an overdiagnosis estimate of 66 % ; in the model that was calibrated to the US data , these were 6.9 years and 42 % , respectively . CON 
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Little information was provided about potential harms associated with screening .
CONCLUSIONS The existing evidence from r and omised controlled trials does not support the routine use of screening for prostate cancer with prostate specific antigen with or without digital rectal examination