***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    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 Prostate cancer ( PC ) screening with prostate-specific antigen ( PSA ) has been shown to decrease PC mortality by the European R and omized Study of Screening for Prostate Cancer ( ERSPC ) . We evaluated mortality results in the Finnish Prostate Cancer Screening Trial , the largest component of ERSPC . The primary endpoint was PC-specific mortality . METHODS A total of 80 144 men were identified from the population registry and r and omized to either a  screening arm ( SA ) or a  control arm ( CA ) . Men in the SA were invited to serum PSA determination up to three times with a 4-year interval between each scan and referred to biopsy if the PSA concentration was greater than or equal to 4.0 ng/mL or 3.0 to 3.99 ng/mL with a free/total PSA ratio less than or equal to 16 % . Men in the CA received usual care . The analysis covers follow-up to 12 years from r and omization for all men . Hazard ratios ( HRs ) were estimated for incidence and mortality using Cox proportional hazard model . All statistical tests were two-sided . RESULTS PC incidence was 8.8 per 1000 person-years in the SA and 6.6 in the CA ( HR = 1.34 , 95 % confidence interval [ CI ] = 1.27 to 1.40 ) . The incidence of advanced PC was lower in the SA vs CA arm ( 1.2 vs 1.6 , respectively ; HR = 0.73 , 95 % CI = 0.64 to 0.82 ; P < .001 ) . For PC mortality , no statistically significant difference was observed between the SA and CA ( HR = 0.85 , 95 % CI = 0.69 to 1.04 ) ( with intention-to-screen analysis ) . To avoid one PC death , we needed to invite 1199 men to screening and to detect 25 PCs . We observed no difference in all-cause mortality between trial arms . CONCLUSIONS At 12 years , a relatively conservative screening protocol produced a small , non-statistically significant PC-specific mortality reduction in the Finnish trial , at the cost of moderate overdiagnosis 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 Objective To assess whether screening for prostate cancer reduces prostate cancer specific mortality . Design Population based r and omised controlled trial . Setting Department of Urology , Norrköping , and the South-East Region Prostate Cancer Register . Participants All men aged 50 - 69 in the city of Norrköping , Sweden , identified in 1987 in the National Population Register ( n=9026 ) . Intervention From the study population , 1494 men were r and omly allocated to be screened by including every sixth man from a list of date s of birth . These men were invited to be screened every third year from 1987 to 1996 . On the first two occasions screening was done by digital rectal examination only . From 1993 , this was combined with prostate specific antigen testing , with 4 µg/L as cut off . On the fourth occasion ( 1996 ) , only men aged 69 or under at the time of the investigation were invited . Main outcome measures Data on tumour stage , grade , and treatment from the South East Region Prostate Cancer Register . Prostate cancer specific mortality up to 31 December 2008 . Results In the four screenings from 1987 to 1996 attendance was 1161/1492 ( 78 % ) , 957/1363 ( 70 % ) , 895/1210 ( 74 % ) , and 446/606 ( 74 % ) , respectively . There were 85 cases ( 5.7 % ) of prostate cancer diagnosed in the screened group and 292 ( 3.9 % ) in the control group . The risk ratio for death from prostate cancer in the screening group was 1.16 ( 95 % confidence interval 0.78 to 1.73 ) . In a Cox proportional hazard analysis comparing prostate cancer specific survival in the control group with that in the screened group , the hazard ratio for death from prostate cancer was 1.23 ( 0.94 to 1.62 ; P=0.13 ) . After adjustment for age at start of the study , the hazard ratio was 1.58 ( 1.06 to 2.36 ; P=0.024 ) . Conclusions After 20 years of follow-up the rate of death from prostate cancer did not differ significantly between men in the screening group and those in the  control group . Trial registration Current Controlled Trials , IS RCT N06342431 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  
    Output:
    
There was no evidence of a PC mortality reduction in the American PLCO trial , which investigated a screening program in a setting where opportunistic screening was already common practice .
Given that opportunistic PSA screening practice s in Canada are similar , it is unlikely that the introduction of a formal PSA screening program would reduce PC mortality