Original Article
Screening and Prostate-Cancer Mortality in a Randomized European Study
N Engl J Med 2009; 360:1320-1328March 26, 2009
- Abstract
Background
The European Randomized 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 randomly 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, ISRCTN49127736.)
Media in This Article
Figure 1
Enrollment and Outcomes, According to Age Group at Randomization.Figure 2
Cumulative Risk of Death from Prostate Cancer.Article Activity
- Article
Measurement of serum prostate-specific antigen (PSA), a biomarker for prostate cancer,1 is useful for the detection of early prostate cancer. 2 Nevertheless, the effect of PSA-based screening on prostate-cancer mortality remains unclear.3 The European Randomized Study of Screening for Prostate Cancer (ERSPC) was initiated in the early 1990s to determine whether a reduction of 25% in prostate-cancer mortality could be achieved by PSA-based screening.4 Preliminary data from this study have been published and can be accessed at www.erspc.org. Another randomized screening trial in the United States, the Prostate, Lung, Colon, and Ovarian (PLCO) Cancer Screening Trial, was initiated around the same time, and interim results are also reported in this issue of the Journal.5
Methods
Study Design
We designed the ERSPC as a randomized, multicenter trial of screening for prostate cancer, with the rate of death from prostate cancer as the primary outcome. An independent data and safety monitoring committee reviewed the trial, and interim analyses were carried out according to a monitoring and evaluation plan in which the outcome of the trial was to be presented to the research group once a statistically significant result corrected for interim analyses was reached.6,7 The study's protocol was reviewed by local and governmental ethics committees (for details, see Supplementary Appendix 4, available with the full text of this article at NEJM.org).
Recruitment and randomization procedures differed among countries and were developed in accordance with national regulations. In Finland, Sweden, and Italy, the trial subjects were identified from population registries and underwent randomization before written informed consent was provided (population-based effectiveness trial). In the Netherlands, Belgium, Switzerland, and Spain, the target population was also identified from population lists, but when the men were invited to participate in the trial, only those who provided consent underwent randomization (efficacy trial). The results of analyses from two participating countries were not included in this analysis: investigators in Portugal discontinued their participation in October 2000 because they were unable to provide the necessary data, and investigators in France decided to participate in 2001, so data from their analyses were not included because of the short duration of follow-up. Men in whom prostate cancer had been diagnosed (according to data from questionnaires or registries) were ineligible. Within each country, men were assigned to either the screening group or the control group, without the use of blocks of numbers or stratification on the basis of random-number generators (Figure 1Figure 1
Enrollment and Outcomes, According to Age Group at Randomization.).At all study centers, the core age group included men between the ages of 55 and 69 years at entry. In addition, in Sweden, study investigators included men between the ages of 50 and 54 years, and investigators in the Netherlands, Italy, Belgium, and Spain included men up to the age of 74 years at entry. In Switzerland, men between the ages of 55 and 69 years were included, with screening up to the age of 75 years. In Finland, men were recruited at the ages of 55, 59, 63, and 67 years and were screened until the age of 71 years. Screening was discontinued in all other centers when the chosen upper age limit was reached. The validity of randomization was determined by comparing the age distributions and the rates of death from any cause in the two study groups.
At centers in all countries except Finland, subjects were randomly assigned in a 1:1 ratio to the screening group or the control group. In Finland, the size of the screening group was fixed at 32,000 subjects. Because the whole birth cohort underwent randomization, this led to a ratio, for the screening group to the control group, of approximately 1:1.5.
Each center reported data on recruitment, screening, and mortality twice a year to a central data center. Several task forces and working groups were responsible for quality assurance, including an epidemiology committee, a quality-control committee, a pathology committee, and a PSA committee.7 The data and safety monitoring committee had oversight of the trial, with a mandate to stop the trial on demonstrating a significant difference between the groups or adverse effects of screening. The monitoring committee received reports on the progress of the trial, including prostate-cancer mortality. Causes of death, which were obtained from registries and individual chart review, were assigned according to definitions and procedures developed for the trial. A committee that analyzed causes of death was formed at each center, and an international committee coordinated the work of these national committees.8,9
Screening Tests and Indications for Biopsy
Total PSA was measured with the use of Hybritech assay systems (Beckman Coulter). From 1994 through 2000, the Tandem E assay was used, and thereafter the Access assay, with the original Hybritech calibration always applied.10
Most centers used a PSA cutoff value of 3.0 ng per milliliter as an indication for biopsy. In Finland, a PSA value of 4.0 ng per milliliter or more was defined as positive and the men were referred for biopsy; those with a value of 3.0 to 3.9 ng per milliliter underwent an ancillary test — digital rectal examination until 1998 and calculation of the ratio of the free PSA value to the total PSA value (with a value of ≤0.16) starting in 1999 — and were referred for biopsy if the test was positive. In Italy, a PSA value of 4.0 ng per milliliter or more was defined as positive, but men with a PSA value of 2.5 to 3.9 ng per milliliter also underwent ancillary tests (digital rectal examination and transrectal ultrasonography).
In the Dutch and Belgian centers, up to February 1997, a combination of digital rectal examination, transrectal ultrasonography, and PSA testing (with a cutoff value of 4.0 ng per milliliter) was used for screening; in 1997, this combination was replaced by PSA testing only.7,11,12 In Belgium, where the results of a pilot study (from 1991 to 1994) were included in the final data set up to 1995, a PSA cutoff value of 10.0 ng per milliliter was used initially. Most centers used sextant biopsies guided by transrectal ultrasonography. As of June 1996, lateralized sextant biopsies were recommended.13 In Italy, transperineal sextant biopsies were used. In Finland, a biopsy procedure with 10 to 12 biopsy cores was adopted in 2002 as a general policy for the two study groups.
The screening interval at six of the seven centers was 4 years (accounting for 87% of the subjects); Sweden used a 2-year interval. In Belgium, the interval between the first and second rounds of screening was 7 years because of an interruption in funding.
Pathological Evaluation
The primary evaluation of specimens from biopsies and radical prostatectomies was performed by local pathologists. Central review of the pathological analyses was not carried out. However, standardization of procedures was coordinated and achieved by the work of the international pathology committee. (For details on the committee and its functions, see Supplementary Appendix 3.)
Treatment Policies
The treatment of prostate cancer was performed according to local policies and guidelines. The equality of distribution of treatments that were applied to the screening group and the control group has been evaluated, with little indication of differences between the two study groups after adjustment for disease stage, tumor grade, and age (data not shown).14
Follow-up
Follow-up for mortality analyses began at randomization and ended at death, emigration, or a uniform censoring date (December 31, 2006), with identical follow-up in the two study groups. Causes of death were evaluated in a blinded fashion and according to a standard algorithm9 or, after validation, on the basis of official causes of death. The causes were classified by the independent committees as definite prostate cancer, causes related to screening, probable or possible prostate cancer, and other intercurrent causes (with or without prostate cancer as a contributory factor). Decision points that were used for determining the cause of death have been described previously.9 For this analysis, we have combined the categories of definite and probable prostate cancer and the category of causes related to screening.
Other Analyses
Aspects of quality of life were evaluated in several study centers. A complete evaluation of all the steps of screening was conducted in the Netherlands (data not shown).15-21
Statistical Analysis
The statistical analysis was based on the core age group (including men between the ages of 55 and 69 years at randomization) and on the intention-to-screen principle. Overall mortality was studied to evaluate the correctness of randomization. Poisson regression analysis was used to estimate the ratio of mortality in the intervention group to mortality in the control group, stratified according to study center and age group at randomization. The Nelsen–Aalen method was used for the calculation of cumulative hazard.22 All P values are two-sided. Interim analyses were conducted for follow-up in 2002, 2004, and 2006, with an alpha spending curve with a division of uneven weights.23 A preliminary analysis included men who had actually undergone screening in the first round (with adjustment for noncompliance). The number that would need to be screened to prevent one death from prostate cancer was calculated as the inverse of the absolute difference in cumulative mortality from prostate cancer between the two study groups.
The study had a power of 86% to show a statistically significant difference of 25% or more in prostate-cancer mortality with a P value of 0.05 among men who underwent screening, on the basis of follow-up through 2008.4 The sample-size calculation, which was part of the power calculation, took into account noncompliance in the screening group in each study center and the use of PSA tests outside the protocol assignment in the control group (termed contamination of the control group). On the basis of an overall level of compliance of 82% and 20% contamination in the control group, a 25% reduction in the number of men who underwent screening would be equivalent to a 14% reduction in an intention-to-treat analysis. This assumes that men who were screened and those who were not screened had the same underlying risk and that screening in the control group was as effective as that in the screening group.
Results
Subjects
Figure 1 shows trial enrollment, study-group assignments, and follow-up of all subjects and of the core age group. A total of 162,387 men in the core age group underwent randomization; of these men, 72,952 were assigned to the screening group and 89,435 to the control group. A total of 62 men in the screening group and 82 men in the control group died between identification and randomization.
Table 1Table 1
Numbers of Subjects and Results of Screening, According to Study Center. summarizes the characteristics of the subjects according to the center and the results of screening. The mean age at randomization was 60.8 years (range, 59.6 to 63.0), with little variation among the seven countries. In total, 82.2% of the men in the screening group were screened at least once. Compliance was higher in study centers that obtained consent before randomization (88 to 100%) than in those in which subjects underwent randomization before providing consent (62 to 68%) (for details concerning all age groups, see Table 1A in Supplementary Appendix 5).During the trial, 126,462 PSA-based tests were performed, an average of 2.1 per subject who underwent screening. Overall, 16.2% of all tests were positive, with a range of 11.1 to 22.3% among the centers. The average rate of compliance with biopsy recommendations was 85.8% (range, 65.4 to 90.3). Of the men who underwent biopsy for an elevated PSA value, 13,308 (75.9%) had a false positive result.
We detected 5990 prostate cancers in the screening group and 4307 in the control group. These numbers correspond to a cumulative incidence of 8.2% and 4.8%, respectively. The positive predictive value of a biopsy (the number of cancers detected on screening divided by the number of biopsies expressed as a percentage) was on average 24.1% (range, 18.6 to 29.6). The cumulative incidence of local prostate cancer was higher in the screening group than in the control group (for details about tumor stage, grade distribution, and treatment, see Supplementary Appendixes 6 and 7). For example, the number of men with positive results on a bone scan (or a PSA value of more than 100 ng per milliliter in those without bone-scan results) was 0.23 per 1000 person-years in the screening group, as compared with 0.39 per 1000 person-years in the control group, a 41% reduction in the screening group (P<0.001). The proportions of men who had a Gleason score of 6 or less were 72.2% in the screening group and 54.8% in the control group, and the proportions with a Gleason score of 7 or more were 27.8% in the screening group and 45.2% in the control group.
Prostate-Cancer Mortality
As of December 31, 2006, with average and median follow-up times of 8.8 and 9.0 years in the screening and control groups, respectively, there were 214 prostate-cancer deaths in the screening group and 326 in the control group in the core age group. Deaths that were associated with prostate-cancer–related interventions were categorized as deaths from prostate cancer. The unadjusted rate ratio for death from prostate cancer in the screening group was 0.80 (95% confidence interval [CI], 0.67 to 0.95; P=0.01); after adjustment for sequential testing with alpha spending due to two previous interim analyses (based on Poisson regression analysis), the rate ratio was 0.80 (95% CI, 0.65 to 0.98; P=0.04). The rates of death in the two study groups began to diverge after 7 to 8 years and continued to diverge further over time (Figure 2Figure 2
Cumulative Risk of Death from Prostate Cancer.). Overall mortality results at 30 days are summarized in Supplementary Appendix 8.In the intention-to-screen analysis, the absolute difference between the screening group and the control group was 0.71 prostate-cancer death per 1000 men. This means that in order to prevent one prostate-cancer death, the number of men who would need to be screened would be 1410 (95% CI, 1142 to 1721), with an average of 1.7 screening visits per subject during a 9-year period. The additional prostate cancers diagnosed by screening resulted in an increase in cumulative incidence of 34 per 1000 men, as compared with the control group. In other words, 48 additional subjects (1410÷1000×34) would need to be treated to prevent one death from prostate cancer.
In an analysis of men who were actually screened during the first round (which was adjusted for noncompliance), the rate ratio for prostate-cancer death after 9 years was 0.73 (95% CI, 0.56 to 0.90), which meant that 1068 men would need to be screened and 48 would need to be treated to prevent one death from prostate cancer. The number of men who would need to be treated (48) remained unchanged in the per-protocol analysis because the same number of deaths were prevented and the same number of additional cases were diagnosed in men who actually underwent screening.
Effect of Age on Mortality
In an exploratory analysis of mortality according to age group, there was no evidence of heterogeneity among age groups (Table 2Table 2
Death from Prostate Cancer, According to the Age at Randomization.). Among men between the ages of 50 and 54 years at baseline, the number of events was small, with no obvious screening effect.Heterogeneity of Rate Ratios
In an exploratory analysis of heterogeneity according to study center (which was carried out in accordance with the monitoring plan6), the decrease in the rate of death from prostate cancer in the screening group could not be attributed to any single center, as evidenced by rate ratios ranging between 0.74 and 0.84 after the exclusion of each center, one at a time. There was no significant difference in overall mortality (Table 3Table 3
Rate Ratios for Death from Any Cause and Death from Prostate Cancer, with Exclusions According to Location of Study Center.).Adverse Events
No deaths were reported as a direct complication (e.g., septicemia or bleeding) associated with a biopsy procedure. Complications associated with screening procedures (including prostate biopsy) have been reported previously.24,25
Discussion
In an intention-to-screen analysis of data from seven European centers, PSA screening was associated with a significant absolute reduction of 0.71 prostate-cancer death per 1000 men after an average follow-up of 8.8 years (median, 9.0). This finding corresponds to a relative reduction of 20% in the rate of death from prostate cancer among men between the ages of 55 and 69 years at study entry, given an average screening interval of 4 years and a compliance rate of 82% of those who accepted the offer of screening (rate ratio, 0.80; adjusted P=0.04). To prevent one prostate-cancer death, 1410 men (or 1068 men who actually underwent screening) would have to be screened, and an additional 48 men would have to be treated. The high number of men who would need to be treated could be improved by avoiding the diagnosis and treatment of indolent cancers during screening or by improving treatment in the remaining men with cancer. The number needed to screen in our study is similar to that in studies of mammographic screening for breast cancer and fecal occult-blood testing for colorectal cancer.26,27
Our analysis shows that the results were generally similar in all participating study centers considered individually (Table 3). The trial was not powered to evaluate mortality differences between centers or for age subgroups. The results were based on a combined analysis of data from centers sharing a common core protocol, which defined the minimal criteria for inclusion and the scope of the primary analysis but allowed wider age ranges or shorter screening intervals. Because of various recruitment approaches, the estimate of a 20% reduction in prostate-cancer mortality does not represent the effect of a screening program at the population level or the effect on individual subjects but instead represents a mixture of such estimates. Despite some variation in screening procedures, the results from each center were compatible with the main result: a lowering of the death rate from prostate cancer associated with screening.
The screening interval of 4 years was chosen on the basis of the mean lead time of 5 to 10 years in PSA-based screening.28,29 However, the lead time of aggressive cancers, which may be the most important target of screening, is likely to be much shorter.
The benefit of screening was restricted to the core age group of subjects who were between the ages of 55 and 69 years at the time of randomization. The results that were seen in other age groups are preliminary and inconclusive. Our findings are early results of the trial, and continued follow-up will provide further information. Adjustment for noncompliance resulted in a greater effect among men who actually underwent screening, and after adjustment for both noncompliance and contamination, the effect of screening in the intention-to-screen analysis is likely to be further enhanced.
The rate of overdiagnosis of prostate cancer (defined as the diagnosis in men who would not have clinical symptoms during their lifetime) has been estimated to be as high as 50% in the screening group.30 Consistent estimates of overdiagnosis (a third of cancers detected on screening) have also been obtained by identifying potentially indolent prostate cancers on the basis of clinical and pathological characteristics.31-33– Overdiagnosis and overtreatment are probably the most important adverse effects of prostate-cancer screening and are vastly more common than in screening for breast, colorectal, or cervical cancer. 34
Although the results of our trial indicate a reduction in prostate-cancer mortality associated with PSA screening, the introduction of population-based screening must take into account population coverage, overdiagnosis, overtreatment, quality of life, cost, and cost-effectiveness. The ratio of benefits to risks that is achievable with more frequent screening or a lower PSA threshold than we used remains unknown. Further analyses are needed to determine the optimal screening interval in consideration of the PSA value at the first screening and of previously negative results on biopsy.35-38
Supported by grants from Europe Against Cancer and the fifth and sixth framework program of the European Union, by grants from agencies or health authorities in the participating countries, and by unconditional grants from Beckman Coulter. The studies in each national center were funded by numerous local grants (see Supplementary Appendix 2).
Dr. Hugosson reports receiving lecture fees from GlaxoSmithKline; Dr. Tammela, receiving consulting or lecture fees from GlaxoSmithKline, Pfizer, AstraZeneca, Leiras, and Novartis; and Dr. Lilja, holding a patent for an assay for free PSA. No other potential conflict of interest relevant to this article was reported.
This article (10.1056/NEJMoa0810084) was published at NEJM.org on March 18, 2009.
Source Information
The authors' affiliations are listed in the Appendix.
Address reprint requests to Dr. Schröder at the Erasmus Medical Center, P.O. Box 2040, Rotterdam 3000 CA, the Netherlands, or at secr.schroder@erasmusmc.nl.
Members of the European Randomized Study of Screening for Prostate Cancer (ERSPC) are listed in the Appendix.
Appendix
The authors' affiliations are as follows: the Departments of Urology (F.H.S., M.J.R., C.H.B.), Pathology (T.K.), Clinical Chemistry (B.G.B.), and Public Health (H.J.K.), Erasmus Medical Center, Rotterdam, the Netherlands; the Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden (J.H., G.A.); the Department of Urology, Tampere University Hospital (T.L.J.T.), and Tampere School of Public Health, University of Tampere (A.A.) — both in Tampere, Finland; the Department of Diagnostic Medical Imaging (S.C.) and Unit of Epidemiology (M.Z.), Institute for Cancer Prevention, Florence, Italy; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium (V.N.); the Department of Urology, Kantonsspital Aarau, Aarau, Switzerland (M.K., F.R.); the Department of Urology, Hospital Universitario de Getafe, Madrid (M.L., A.B.); the Department of Laboratory Medicine, Lund University, Malmö University Hospital, Malmö, Sweden, and Memorial Sloan-Kettering Cancer Center, New York (H.L.); Oncology Center Antwerp, Antwerp, Belgium (L.J.D.); Finnish Cancer Registry, Helsinki (L.M.); the Department of Urology, Centre Hospitalier Regional Universitaire, Lille, France (A.V.); the Department of Urology, Clinique de Beau Soleil, Montpellier, France (X.R.); and the Cancer Screening Evaluation Unit, Surrey, United Kingdom (S.M.M.).
The members of the data and safety monitoring committee were as follows: P. Smith (chair), J. Adolfsson, and T. Hakulinen, who carried out interim analyses of the data by relating the central messages on the progress of the study to the voting members; J. Chamberlain and B. Collette, earlier committee members; F. Alexander, who served as the trial statistician until her retirement; and I. de Beaufort, who served as an advisor. Additional study members are listed in Supplementary Appendix 1.
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Citing Articles
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Michael Marberger, Jelle Barentsz, Mark Emberton, Jonas Hugosson, Stacy Loeb, Laurence Klotz, Michael Koch, Shahrokh F. Shariat, Andrew Vickers. (2012) Novel approaches to improve prostate cancer diagnosis and management in early-stage disease. BJU International 109, 1-7
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Jüri R. Palisaar, Joachim Noldus, Björn Löppenberg, Christian von Bodman, Florian Sommerer, Thilo Eggert. (2012) Comprehensive report on prostate cancer misclassification by 16 currently used low-risk and active surveillance criteria. BJU Internationalno-no
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Stacy Loeb, E. Jeffrey Metter, Donghui Kan, Kimberly A. Roehl, William J. Catalona. (2012) Prostate-specific antigen velocity (PSAV) risk count improves the specificity of screening for clinically significant prostate cancer. BJU Internationalno-no
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Andrew J. Vickers, Monique J. Roobol, Hans Lilja. (2012) Screening for Prostate Cancer: Early Detection or Overdetection?. Annual Review of Medicine 63:1, 161-170
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Hashim Uddin Ahmed, Mark Emberton, Gordon Kepner, Jeremy Kepner. (2012) A biomedical engineering approach to mitigate the errors of prostate biopsy. Nature Reviews Urology
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Thomas A. Dunn, Helen L. Fedor, Angelo M. De Marzo, Jun Luo. (2012) Molecular profiling of indolent human prostate cancer: tackling technical challenges to achieve high-fidelity genome-wide data. Asian Journal of Andrology
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Vinay Prasad, Adam Cifu. (2012) A medical burden of proof: Towards a new ethic. BioSocieties
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Daniel J. Underwood, Jingyu Zhang, Brian T. Denton, Nilay D. Shah, Brant A. Inman. (2012) Simulation optimization of PSA-threshold based prostate cancer screening policies. Health Care Management Science
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Yair Lotan. (2012) The Challenges of Harnessing New Technology. European Urology 61:2, 269-270
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Pierre Colin, Pierre Nevoux, Mohamad Marqa, Florent Auger, Xavier Leroy, Arnauld Villers, Philippe Puech, Serge Mordon, Nacim Betrouni. (2012) Focal laser interstitial thermotherapy (LITT) at 980 nm for prostate cancer: treatment feasibility in Dunning R3327-AT2 rat prostate tumour. BJU International 109:3, 452-458
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Roderick C.N. van den Bergh, Ida J. Korfage, Monique J. Roobol, Chris H. Bangma, Harry J. de Koning, Ewout W. Steyerberg, Marie-Louise Essink-Bot. (2012) Sexual function with localized prostate cancer: active surveillance vs radical therapy. BJU Internationalno-no
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Amin Zollanvari, Ulisses Braga-Neto, Edward R. Dougherty. (2012) Exact representation of the second-order moments for resubstitution and leave-one-out error estimation for linear discriminant analysis in the univariate heteroskedastic Gaussian model. Pattern Recognition 45:2, 908-917
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Khurshid R. Ghani, Quoc-Dien Trinh, Mani Menon. (2012) THE PHANTOM MENACE OF PROSTATE CANCER SCREENING. BJU International 109:3, 324-326
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Lucille Lee, Louis Potters. 2012. Image-Guided External Beam Radiotherapy. , 1376-1392.
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Meelan Bul, Roderick C.N. van den Bergh, Antti Rannikko, Riccardo Valdagni, Tom Pickles, Chris H. Bangma, Monique J. Roobol. (2012) Predictors of Unfavourable Repeat Biopsy Results in Men Participating in a Prospective Active Surveillance Program. European Urology 61:2, 370-377
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Nicolaas Lumen, Valérie Fonteyne, Gert De Meerleert, Piet Ost, Geert Villeirs, Alexandre Mottrie, Pieter De Visschere, Bart De Troyer, Willem Oosterlinck. (2012) Population screening for prostate cancer: An overview of available studies and meta-analysis. International Journal of Urology 19:2, 100-108
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E. Bismarck, B.J. Schmitz-Dräger, O. Schöffski. (2012) Was erwartet die Medizin von der Gesundheitsökonomie?. Der Urologe
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G. L. Andriole, E. D. Crawford, R. L. Grubb, S. S. Buys, D. Chia, T. R. Church, M. N. Fouad, C. Isaacs, P. A. Kvale, D. J. Reding, J. L. Weissfeld, L. A. Yokochi, B. O'Brien, L. R. Ragard, J. D. Clapp, J. M. Rathmell, T. L. Riley, A. W. Hsing, G. Izmirlian, P. F. Pinsky, B. S. Kramer, A. B. Miller, J. K. Gohagan, P. C. Prorok, . (2012) Prostate Cancer Screening in the Randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: Mortality Results after 13 Years of Follow-up. JNCI Journal of the National Cancer Institute 104:2, 125-132
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Timothy A. Yap, Charles Swanton, Johann S. Bono. (2012) Personalization of prostate cancer prevention and therapy: are clinically qualified biomarkers in the horizon?. The EPMA Journal
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H Serag, S Banerjee, K Saeb-Parsy, S Irving, K Wright, S Stearn, A Doble, V J Gnanapragasam. (2012) Risk profiles of prostate cancers identified from UK primary care using national referral guidelines. British Journal of Cancer
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Yu Chen, Howard I. Scher. (2012) Prostate cancer in 2011: Hitting old targets better and identifying new targets. Nature Reviews Clinical Oncology
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Rowan G Casey, Niall M Corcoran, S Larry Goldenberg. (2012) Quality of life issues in men undergoing androgen deprivation therapy: a review. Asian Journal of Andrology
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A. M. Smith, V. J. Findlay, S. G. Bandurraga, E. Kistner-Griffin, L. S. Spruill, A. Liu, A. R. Golshayan, D. P. Turner. (2012) ETS1 transcriptional activity is increased in advanced prostate cancer and promotes the castrate resistant phenotype. Carcinogenesis
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Luca Carmignani, Stefano Picozzi, Stefano Casellato, Giorgio Bozzini, Carlo Marenghi, Alberto Macchi, Luca Lunelli, Barbara Rubino, Claudio Clemente. (2012) A Proposed New Technique in Prostate Cancer Tissue Bio-Banking: Our Experience with a New Protocol. Pathology & Oncology Research
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Steven B. Zeliadt, Diana S.M. Buist, Robert J. Reid, David C. Grossman, Jian Ma, Ruth Etzioni. (2012) Biopsy Follow-Up of Prostate-Specific Antigen Tests. American Journal of Preventive Medicine 42:1, 37-43
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Michael J. Donovan, Faisal M. Khan, Valentina Bayer-Zubek, Douglas Powell, Jose Costa, Carlos Cordon-Cardo. (2012) A systems-based modelling approach using transurethral resection of the prostate (TURP) specimens yielded incremental prognostic significance to Gleason when predicting long-term outcome in men with localized prostate cancer. BJU International 109:2, 207-213
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Glen B. Taksler, Nancy L. Keating, David M. Cutler. (2012) Explaining racial differences in prostate cancer mortality. Cancern/a-n/a
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Stacy Loeb, Suzanne van den Heuvel, Xiaoye Zhu, Chris H. Bangma, Fritz H. Schröder, Monique J. Roobol. (2012) Infectious Complications and Hospital Admissions After Prostate Biopsy in a European Randomized Trial. European Urology
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Christopher E Barbieri, Francesca Demichelis, Mark A Rubin. (2012) Molecular genetics of prostate cancer: emerging appreciation of genetic complexity. Histopathology 60:1, 187-198
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Dan Lewinshtein, Brandon Teng, Ashley Valencia, Robert Gibbons, Christopher R. Porter. (2012) The Association between pre-operative PSA and prostate cancer-specific mortality in patients with long-term follow-up after radical prostatectomy. The Prostate 72:1, 24-29
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Raghuraman Kannan, Ajit Zambre, Nripen Chanda, Rajesh Kulkarni, Ravi Shukla, Kavita Katti, Anandhi Upendran, Cathy Cutler, Evan Boote, Kattesh V. Katti. (2012) Functionalized radioactive gold nanoparticles in tumor therapy. Wiley Interdisciplinary Reviews: Nanomedicine and Nanobiotechnology 4:1, 42-51
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Kerry N.L. Avery, Chris Metcalfe, Kavita Vedhara, J. Athene Lane, Michael Davis, David E. Neal, Freddie C. Hamdy, Jenny L. Donovan, Jane M. Blazeby. (2012) Predictors of Attendance for Prostate-Specific Antigen Screening Tests and Prostate Biopsy. European Urology
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Grace Hui-Min Wu, Anssi Auvinen, Liisa Määttänen, Teuvo L.J. Tammela, Ulf-Håkan Stenman, Matti Hakama, Amy Ming-Fang Yen, Hsiu-Hsi Chen. (2012) Number of screens for overdetection as an indicator of absolute risk of overdiagnosis in prostate cancer screening. International Journal of Cancern/a-n/a
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Stacy Loeb, H. Ballentine Carter, William J. Catalona, Judd W. Moul, Fritz H. Schroder. (2012) Baseline Prostate-Specific Antigen Testing at a Young Age. European Urology 61:1, 1-7
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Rodolfo Montironi, Marina Scarpelli, Roberta Mazzucchelli, Liang Cheng, Antonio Lopez-Beltran, Francesco Montorsi. (2012) Extent of Cancer of Less Than 50% in Any Prostate Needle Biopsy Core: How Many Millimeters Are There?. European Urology
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Dan Berney, Liang Cheng. (2012) Prostate cancer: towards the standardization and synthesis of morphology, genetics, and prognosis. Histopathology 60:1, 1-3
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Pim J. van Leeuwen, Monique J. Roobol, Ries Kranse, Marco Zappa, Sigrid Carlsson, Meelan Bul, Xiaoye Zhu, Chris H. Bangma, Fritz H. Schröder, Jonas Hugosson. (2012) Towards an Optimal Interval for Prostate Cancer Screening. European Urology 61:1, 171-176
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Alvin C. Goh, Marc A. Kowalkowski, Donald E. Bailey Jr, Meredith W. Kazer, Sara J. Knight, David M. Latini. (2012) Perception of cancer and inconsistency in medical information are associated with decisional conflict: a pilot study of men with prostate cancer who undergo active surveillance. BJU Internationalno-no
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Nicolas M. Furiak, Kristin Kahle-Wrobleski, Christopher Callahan, Timothy M. Klein, Robert W. Klein, Eric R. Siemers. (2012) Screening and treatment for Alzheimer's disease: Predicting population-level outcomes. Alzheimer's and Dementia 8:1, 31-38
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Seth A. Strope, Gerald L. Andriole. (2012) Prostate-Specific Antigen–Based Risk Assessment in Younger Men. European Urology 61:1, 8-9
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Shiro Hinotsu. (2012) Editorial Comment to Population screening for prostate cancer: An overview of available studies and meta-analysis. International Journal of Urologyno-no
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Grace Hui-Min Wu, Anssi Auvinen, Amy Ming-Fang Yen, Matti Hakama, Teuvo L. Tammela, Ulf-Håkan Stenman, Paula Kujala, Mirja Ruutu, Hsiu-Hsi Chen. (2012) The Impact of Interscreening Interval and Age on Prostate Cancer Screening With Prostate-Specific Antigen. European Urology
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Yasemin Hocaoglu, Michael Seitz, Christian G. Seitz, Patrick J. Bastian. (2012) PSA-Screening und Tastuntersuchung bereits ab 40 empfohlen. MMW - Fortschritte der Medizin 154:1, 43-47
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Neil E Fleshner, M Scott Lucia, Blair Egerdie, Lorne Aaron, Gregg Eure, Indrani Nandy, Libby Black, Roger S Rittmaster. (2012) Dutasteride in localised prostate cancer management: the REDEEM randomised, double-blind, placebo-controlled trial. The Lancet
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A. Heidenreich, J. Bellmunt, M. Bolla, S. Joniau, M. Mason, V. Matveev, N. Mottet, H.P. Schmid, T. van der Kwast, T. Wiegel, F. Zattoni. (2012) EAU guidelines on prostate cancer. Part I: screening, diagnosis, and treatment of clinically localised disease. Actas Urológicas Españolas (English Edition)
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Maciej Kwiatkowski, Laurence Klotz, Jonas Hugosson, Franz Recker. (2012) Comment on the US Preventive Services Task Force's Draft Recommendation on Screening for Prostate Cancer. European Urology
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Samarpit Rai, Abhishek Srivastava, Prasanna Sooriakumaran, Ashutosh Tewari. (2012) Advances in imaging the neurovascular bundle. Current Opinion in Urology1
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Osamu Ukimura, Kenneth Faber, Inderbir S. Gill. (2012) Intraprostatic targeting. Current Opinion in Urology1
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F. Recker. (2012) „U.S. Preventive Services Task Force Recommendation“ oder „Das Kind mit dem Bade ausschütten“. Der Urologe 51:1, 74-76
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Mohamed H. Kamel, Page C. Moore, Nabil K. Bissada, Samy M. Heshmat. (2012) Potential Years of Life Lost Due to Urogenital Cancer in the United States: Trends From 1972 to 2006 Based on Data From the SEER Database. The Journal of Urology
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Simon P. Kim, R. Jeffrey Karnes. (2012) An Editorial Response to the USPTF. Journal of Men's Health
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Monique J. Roobol, F. H. Schröder, Jonas Hugosson, J. Stephen Jones, Michael W. Kattan, Eric A. Klein, Freddie Hamdy, David Neal, Jenny Donovan, Dipen J. Parekh, Donna Ankerst, George Bartsch, Helmut Klocker, Wolfgang Horninger, Amine Benchikh, Gilles Salama, Arnauld Villers, Stephen J. Freedland, Daniel M. Moreira, Andrew J. Vickers, Hans Lilja, Ewout W. Steyerberg. (2011) Importance of prostate volume in the European Randomised Study of Screening for Prostate Cancer (ERSPC) risk calculators: results from the prostate biopsy collaborative group. World Journal of Urology
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W. G. Nelson. (2011) Profiling prostate cancer. Proceedings of the National Academy of Sciences 108:52, 20861-20862
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M. Edward Stefanek. (2011) Uninformed Compliance or Informed Choice? A Needed Shift in Our Approach to Cancer Screening. JNCI Journal of the National Cancer Institute 103:24, 1821-1826
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Xiaoye Zhu, Pim J. van Leeuwen, Meelan Bul, Chris H. Bangma, Monique J. Roobol, Fritz H. Schröder. (2011) Identifying and characterizing “escapes”-men who develop metastases or die from prostate cancer despite screening (ERSPC, section Rotterdam). International Journal of Cancer 129:12, 2847-2854
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2011. Role of Disease Prevention in Health Care Reform. , 57-72.
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Ruben Cremers, Christi Asperen, Paul Kil, Hans Vasen, Tjerk Wiersma, Inge Oort, Lambertus Kiemeney. (2011) Urologists’ and GPs’ knowledge of hereditary prostate cancer is suboptimal for prostate cancer counseling: a nation-wide survey in The Netherlands. Familial Cancer
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M Nomura, K Ito, M Miyakubo, Y Sekine, Y Tamura, N Shimizu, S Aoki, K Suzuki. (2011) Development and external validation of a nomogram for predicting cancer probability at initial prostate biopsy using the life expectancy- and prostate volume-adjusted biopsy scheme. Prostate Cancer and Prostatic Diseases
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Sergey Kravchick, Ronit Peled, Shmuel Cytron. (2011) Watchful Waiting and Active Surveillance Approach in Patients with Low Risk Localized Prostatic Cancer: An Experience of Out-Patients Clinic with 12-Year Follow-Up. Pathology & Oncology Research 17:4, 893-897
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H. Ballentine Carter. (2011) Management of low (favourable)-risk prostate cancer. BJU International 108:11, 1684-1695
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Janet Colli, Oliver Sartor, Raju Thomas, Benjamin R. Lee. (2011) Does Urological Cancer Mortality Increase With Low Population Density of Physicians?. The Journal of Urology 186:6, 2342-2346
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Margaritis Avgeris, Konstantinos Stravodimos, Andreas Scorilas. (2011) Kallikrein-related peptidase 4 gene (KLK4) in prostate tumors: Quantitative expression analysis and evaluation of its clinical significance. The Prostate 71:16, 1780-1789
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Hanna Vasarainen, Utku Lokman, Mirja Ruutu, Kimmo Taari, Antti Rannikko. (2011) Prostate cancer active surveillance and health-related quality of life: results of the Finnish arm of the prospective trial. BJU Internationalno-no
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Daniel Seiler, Marco Randazzo, Laurence Klotz, Rainer Grobholz, Martin Baumgartner, Hendrik Isbarn, Franz Recker, Maciej Kwiatkowski. (2011) Pathological stage distribution in patients treated with radical prostatectomy reflecting the need for protocol-based active surveillance: results from a contemporary European patient cohort. BJU Internationalno-no
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Suzanne K. Linder, Paul R. Swank, Sally W. Vernon, Patricia D. Mullen, Robert O. Morgan, Robert J. Volk. (2011) Validity of a low literacy version of the Decisional Conflict Scale. Patient Education and Counseling 85:3, 521-524
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Barbara Joyce Davison, Erin Breckon. (2011) Factors influencing treatment decision making and information preferences of prostate cancer patients on active surveillance. Patient Education and Counseling
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S. Kadiyala, E. C. Strumpf. (2011) Are United States and Canadian cancer screening rates consistent with guideline information regarding the age of screening initiation?. International Journal for Quality in Health Care 23:6, 611-620
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Marisa A. Kollmeier, Michael J. Zelefsky. (2011) How to select the optimal therapy for early-stage prostate cancer. Critical Reviews in Oncology/Hematology
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Ryan J. Halter, Alan R. Schned, John A. Heaney, Alex Hartov. (2011) Passive bioelectrical properties for assessing high- and low-grade prostate adenocarcinoma. The Prostate 71:16, 1759-1767
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Kazuhiko Ogawa, Katsumasa Nakamura, Tomonari Sasaki, Hiroshi Onishi, Masahiko Koizumi, Masayuki Araya, Nobutaka Mukumoto, Teruki Teshima, Michihide Mitsumori. (2011) Radical External Beam Radiotherapy for Clinically Localized Prostate Cancer in Japan: Changing Trends in the Patterns of Care Process Survey. International Journal of Radiation Oncology*Biology*Physics 81:5, 1310-1318
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John H. Nichols, Stacy Loeb, E. Jeffrey Metter, Luigi Ferrucci, H. Ballentine Carter. (2011) The relationship between prostate volume and prostate-specific antigen variability: data from the Baltimore Longitudinal Study of Aging and the Johns Hopkins Active Surveillance Program. BJU Internationalno-no
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Stacy Loeb, Bruce J. Trock. (2011) Re: Randomised Prostate Cancer Screening Trial: 20 Year Follow-up. European Urology 60:6, 1306-1307
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Joan S. Ko, Patricia Landis, H. Ballentine Carter, Alan W. Partin. (2011) Effect of intra-observer variation in prostate volume measurement on prostate-specific antigen density calculations among prostate cancer active surveillance participants. BJU International 108:11, 1739-1742
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Harvey Quon, Andrew Loblaw, Robert Nam. (2011) Dramatic increase in prostate cancer cases by 2021. BJU International 108:11, 1734-1738
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Roman Gulati, Angela B. Mariotto, Shu Chen, John L. Gore, Ruth Etzioni. (2011) Long-term projections of the harm-benefit trade-off in prostate cancer screening are more favorable than previous short-term estimates. Journal of Clinical Epidemiology 64:12, 1412-1417
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D I Chu, C De Nunzio, L Gerber, J-A Thomas, E E Calloway, S Albisinni, C Senocak, M G McKeever, D M Moreira, A Tubaro, J W Moul, S J Freedland, L L Bañez. (2011) Predictive value of digital rectal examination for prostate cancer detection is modified by obesity. Prostate Cancer and Prostatic Diseases 14:4, 346-353
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Tuomas P. Kilpeläinen, Teuvo L.J. Tammela, Monique Roobol, Jonas Hugosson, Stefano Ciatto, Vera Nelen, Sue Moss, Liisa Määttänen, Anssi Auvinen. (2011) False-positive screening results in the European randomized study of screening for prostate cancer. European Journal of Cancer 47:18, 2698-2705
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(2011) Cancer in Australia: Actual incidence and mortality data from 1982 to 2007 and projections to 2010. Asia-Pacific Journal of Clinical Oncology 7:4, 325-338
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Michael B. Nichol, Joanne Wu, Joice Huang, Dwight Denham, Stanley K. Frencher, Steven J. Jacobsen. (2011) Cost-effectiveness of Prostate Health Index for prostate cancer detection. BJU Internationalno-no
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Anssi Auvinen. (2011) Number needed to screen—How can we project outside context?. Journal of Clinical Epidemiology 64:12, 1275-1276
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Hashim U. Ahmed, Oguz Akin, Jonathan A. Coleman, Sarah Crane, Mark Emberton, Larry Goldenberg, Hedvig Hricak, Mike W. Kattan, John Kurhanewicz, Caroline M. Moore, Chris Parker, Thomas J. Polascik, Peter Scardino, Nicholas van As, Arnauld Villers, . (2011) Transatlantic Consensus Group on active surveillance and focal therapy for prostate cancer. BJU Internationalno-no
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Lih-Ming Wong, Richard Johnston, Naomi Sharma, Nimish C. Shah, Anne Y. Warren, David E. Neal. (2011) General application of the National Institute for Health and Clinical Excellence (NICE) guidance for active surveillance for men with prostate cancer is not appropriate in unscreened populations. BJU Internationalno-no
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Stewart Justman. (2011) What's Wrong With Chemoprevention of Prostate Cancer?. The American Journal of Bioethics 11:12, 21-25
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Eric Schiffer, Carsten Bick, Branko Grizelj, Stephan Pietzker, Wolfgang Schöfer. (2011) Urinary proteome analysis for prostate cancer diagnosis: Cost-effective application in routine clinical practice in Germany. International Journal of Urologyno-no
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Yusuke Goto, Kazuyoshi Nozumi, Kanetaka Miyazaki, Akihiro Matsumoto, Atsushi Inoue, Hiroki Kito, Naoki Hasegawa, Maki Nagata, Yukio Kakuta, Hiroyoshi Suzuki, Kunio Yamaguchi. (2011) Active surveillance criteria for prostate cancer: Can they be applied to Japanese patients?. International Journal of Urologyno-no
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Ákos Végvári, Melinda Rezeli, Carina Sihlbom, Jari Häkkinen, Elisabet Carlsohn, Johan Malm, Hans Lilja, Thomas Laurell, György Marko-Varga. (2011) Molecular microheterogeneity of prostate specific antigen in seminal fluid by mass spectrometry. Clinical Biochemistry
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Andrew J. Vickers, Hans Lilja. (2011) Urological cancer: Time for another rethink on prostate cancer screening. Nature Reviews Clinical Oncology 9:1, 7-8
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G E Tasian, M R Cooperberg, M B Potter, J E Cowan, K L Greene, P R Carroll, J M Chan. (2011) PSA screening: determinants of primary-care physician practice patterns. Prostate Cancer and Prostatic Diseases
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Kyle O. Rove, E. David Crawford. (2011) Randomized controlled screening trials for prostate cancer using prostate-specific antigen: a tale of contrasts. World Journal of Urology
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Magali Gary-Bobo, Youssef Mir, Cédric Rouxel, David Brevet, Ilaria Basile, Marie Maynadier, Ophélie Vaillant, Olivier Mongin, Mireille Blanchard-Desce, Alain Morère, Marcel Garcia, Jean-Olivier Durand, Laurence Raehm. (2011) Mannose-Functionalized Mesoporous Silica Nanoparticles for Efficient Two-Photon Photodynamic Therapy of Solid Tumors. Angewandte Chemie International Edition 50:48, 11425-11429
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Magali Gary-Bobo, Youssef Mir, Cédric Rouxel, David Brevet, Ilaria Basile, Marie Maynadier, Ophélie Vaillant, Olivier Mongin, Mireille Blanchard-Desce, Alain Morère, Marcel Garcia, Jean-Olivier Durand, Laurence Raehm. (2011) Mannose-Functionalized Mesoporous Silica Nanoparticles for Efficient Two-Photon Photodynamic Therapy of Solid Tumors. Angewandte Chemie 123:48, 11627-11631
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Schröder, Fritz H., . (2011) Stratifying Risk — The U.S. Preventive Services Task Force and Prostate-Cancer Screening. New England Journal of Medicine 365:21, 1953-1955
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McNaughton-Collins, Mary F., Barry, Michael J., . (2011) One Man at a Time — Resolving the PSA Controversy. New England Journal of Medicine 365:21, 1951-1953
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Caroline Schroten, Natasja F. Dits, Ewout W. Steyerberg, Ries Kranse, Arno G. J. L. H. Leenders, Chris H. Bangma, Robert Kraaij. (2011) The additional value of TGFβ1 and IL-7 to predict the course of prostate cancer progression. Cancer Immunology, Immunotherapy
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Peng-Fei Shen, Yu-Chun Zhu, Wu-Ran Wei, Yong-Zhong Li, Jie Yang, Yu-Tao Li, Ding-Ming Li, Jia Wang, Hao Zeng. (2011) The results of transperineal versus transrectal prostate biopsy: a systematic review and meta-analysis. Asian Journal of Andrology
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Andrew J. Vickers, Hans Lilja. (2011) Predicting prostate cancer many years before diagnosis: how and why?. World Journal of Urology
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Bohuslav Melichar, Mario Plebani. (2011) Cancer diagnosis: from dogs to DNA or from DNA to dogs?. Clinical Chemistry and Laboratory Medicine---
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A Marije Hoogland, Guido Jenster, Wytske M van Weerden, Jan Trapman, Theo van der Kwast, Monique J Roobol, Fritz H Schröder, Mark F Wildhagen, Geert JLH van Leenders. (2011) ERG immunohistochemistry is not predictive for PSA recurrence, local recurrence or overall survival after radical prostatectomy for prostate cancer. Modern Pathology
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R Bermudo, D Abia, A Mozos, E García-Cruz, A Alcaraz, Á R Ortiz, T M Thomson, P L Fernández. (2011) Highly sensitive molecular diagnosis of prostate cancer using surplus material washed off from biopsy needles. British Journal of Cancer 105:10, 1600-1607
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Fritz H. Schröder, Marco Zappa. (2011) Prostate-specific antigen testing in Tyrol, Austria: prostate cancer mortality reduction was supported by an update with mortality data up to 2008. International Journal of Public Health
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Jonathan Baden, Scott Adams, Tara Astacio, Jennifer Jones, Jadwiga Markiewicz, Jennifer Painter, Carrie Trust, Yixin Wang, George Green. (2011) Predicting Prostate Biopsy Result in Men With Prostate Specific Antigen 2.0 to 10.0 ng/ml Using an Investigational Prostate Cancer Methylation Assay. The Journal of Urology 186:5, 2101-2106
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Turang Ed Behbahani, Jörg Ellinger, Daniel Garcia Caratozzolo, Stefan C. Müller. (2011) Pathological Outcomes of Men Eligible for Active Surveillance After Undergoing Radical Prostatectomy: Are Results Predictable?. Clinical Genitourinary Cancer
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H. Ho, J.S.P. Yuen, P. Mohan, E.W. Lim, C.W.S. Cheng. (2011) Robotic Transperineal Prostate Biopsy: Pilot Clinical Study. Urology 78:5, 1203-1208
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David D. Ørsted, Børge G. Nordestgaard, Gorm B. Jensen, Peter Schnohr, Stig E. Bojesen. (2011) Prostate-Specific Antigen and Long-Term Prediction of Prostate Cancer Incidence and Mortality in the General Population. European Urology
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F. Bianchi, S. Dugheri, M. Musci, A. Bonacchi, E. Salvadori, G. Arcangeli, V. Cupelli, M. Lanciotti, L. Masieri, S. Serni, M. Carini, M. Careri, A. Mangia. (2011) Fully automated solid-phase microextraction–fast gas chromatography–mass spectrometry method using a new ionic liquid column for high-throughput analysis of sarcosine and N-ethylglycine in human urine and urinary sediments. Analytica Chimica Acta 707:1-2, 197-203
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Thiele Kobus, Thomas Hambrock, Christina A. Hulsbergen-van de Kaa, Alan J. Wright, Jelle O. Barentsz, Arend Heerschap, Tom W.J. Scheenen. (2011) In Vivo Assessment of Prostate Cancer Aggressiveness Using Magnetic Resonance Spectroscopic Imaging at 3 T with an Endorectal Coil. European Urology 60:5, 1074-1080
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Roberto L Muller, Daniel M Moreira. (2011) Smoking and prostate cancer survival and recurrence. Asian Journal of Andrology 13:6, 787-788
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C. Weber. (2011) Diagnostik und Therapie des lokalisierten Prostatakarzinoms. Der Radiologe 51:11, 930-937
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Antoun Toubaji, Roula Albadine, Alan K Meeker, William B Isaacs, Tamara Lotan, Michael C Haffner, Alcides Chaux, Jonathan I Epstein, Misop Han, Patrick C Walsh, Alan W Partin, Angelo M De Marzo, Elizabeth A Platz, George J Netto. (2011) Increased gene copy number of ERG on chromosome 21 but not TMPRSS2–ERG fusion predicts outcome in prostatic adenocarcinomas. Modern Pathology 24:11, 1511-1520
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Xiaoye Zhu, Peter C. Albertsen, Gerald L. Andriole, Monique J. Roobol, Fritz H. Schröder, Andrew J. Vickers. (2011) Risk-Based Prostate Cancer Screening. European Urology
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