Prostate CancerOverall Survival in the Intervention Arm of a Randomized Controlled Screening Trial for Prostate Cancer Compared with a Clinically Diagnosed Cohort
Introduction
In previous decades, 50–85% of men with advanced prostate cancer died from their disease, depending on the age and extent of disease at diagnosis [1], [2]. From the early 1990s onward, the prostate cancer mortality rates have slowly declined in the United States [3] and in some European countries [4], [5], [6], [7]. Some have argued that this decrease is due to the application of the serum prostate-specific antigen (PSA) test as a tool for the early detection of prostate cancer [8], [9]. Indeed, PSA determination in serum has contributed to a rapid increase in the incidence of prostate cancer, and a concurrent stage and grade migration to earlier stages and lower grades of disease. However, this effect of screening on grade and stage does not necessarily translate into a reduction of disease-specific mortality as has been shown for lung cancer [10]. Until now, no beneficial effect of prostate cancer screening on mortality using the serum-PSA test, and its subsequent diagnostic and therapeutic sequelae, has been established in properly performed randomized controlled trials.
This study was performed to compare the distribution of prognostic factors at diagnosis in two cohorts of men subjected to different intensities of prostate cancer screening. Furthermore, overall survival in both cohorts was compared with that in the general population. Through this methodology of the expected survival, the magnitude of lead time and overdiagnosis of disease can be estimated. Baseline characteristics of 822 men diagnosed with prostate cancer in the intervention arm of the Dutch section of the European Randomized Study of Screening for Prostate Cancer (ERSPC) were compared with those in 947 men clinically diagnosed with prostate cancer in a neighboring geographical region in which prostate cancer screening was not common practice. Cases were diagnosed with prostate cancer during periods of time of similar duration. A partitioning of overall survival by variables associated with cancer onset such as age at diagnosis, stage at diagnosis, and grade at diagnosis was performed in both cohorts [11], [12].
Section snippets
Intervention arm of ERSPC
The ERSPC was designed to study the effect of population-based screening for prostate cancer on prostate cancer mortality and quality of life. Between December 1993 and May 1997, in Rotterdam alone, a total of 20,643 men aged 55–75 yr were identified in the population registry, invited to participate, and, after providing informed consent, randomized to the screening study. A total of 10,456 men were randomized to the intervention arm. Men with a prior diagnosis of prostate cancer were
Baseline characteristics
The characteristics of the 822 men diagnosed with prostate cancer in the intervention arm of the screening trial are presented in Table 1. The median age at diagnosis was 67 yr (range, 55–78). A description of the 947 men in the clinically diagnosed cohort is given in Table 1. The median age at diagnosis was 75 yr (range, 47–95).
Overall survival
The median observation period for patients in the intervention arm was 8.1 yr (range, 0.2–11.6) and 4.8 yr (range, 0.1–13.4) for men in the nonscreened cohort. During
Discussion
The current study provides comparisons of the distribution of prognostic factors and outcomes of two cohorts of prostate cancer patients from two well-defined neighboring geographical areas who were exposed to different intensities of prostate cancer screening. The intervention arm of the ERSPC is known to have a 95% screening coverage, whereas at the end of 2004, approximately 30% of men in the control arm had their PSA level measured at least once [21]. This control arm reflects the intensity
Conclusions
The overall survival rate in a contemporary series of men diagnosed with prostate cancer within a population-based screening trial was longer than that of men in a nonrandomized cohort clinically diagnosed with prostate cancer in an adjacent geographical region. Differences in survival were observed for all ages and for all stages and grades of disease, except for metastatic disease at diagnosis.
Differences in baseline characteristics (age, stage, and grade of disease) between cohorts may all
Conflicts of interest
The authors have nothing to disclose.
Acknowledgements
The ERSPC is supported by grants from the Dutch Cancer Society, the Netherlands Organization for Health Research and Development, the European Union, and a grant from Beckman Coulter Hybritech Inc, San Diego, CA, USA.
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2008, Journal of UrologyCitation Excerpt :Nevertheless, even on multivariate analysis controlling for PSA, clinical stage and Gleason grade referral status was the strongest independent predictor of PSAV 2.0 ng/ml per year or greater. In support of our results Vis et al recently reported significantly improved survival in men in the screening arm of ERSPC compared to that in men with clinically diagnosed PCa (88% vs 52% and 68% vs 29% at 5 and 10 years, respectively).20 While they attributed the improvement in survival to the earlier age at PCa diagnosis in screened men, we found a similar benefit in terms of the PSAV profile in screened men in our study.
USEFULNESS OF PSA SCREENING AND COUNTERMEASURES AGAINST OVERDIAGNOSIS AND OVERTREATMENT FOR EARLY STAGE PROSTATE CANCER
2022, Nishinihon Journal of Urology
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These authors contributed equally to this manuscript.