1
|
Yee CW, Harvey MJ, Xin Y, Kirson NY. Cost-Effectiveness Modeling of Prostate-Specific Membrane Antigen Positron Emission Tomography with Piflufolastat F 18 for the Initial Diagnosis of Patients with Prostate Cancer in the United States. PHARMACOECONOMICS 2024; 42:231-247. [PMID: 37934376 PMCID: PMC10811023 DOI: 10.1007/s40273-023-01322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Piflufolastat F 18 is a novel prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) radiotracer that is superior to standard of care (SOC) imaging for the initial staging of prostate cancer and the detection of biochemical recurrence. As piflufolastat F 18 has been approved in the United States (US) for this indication, this modeling study assessed the cost effectiveness of piflufolastat F 18 versus fluciclovine F-18, gallium68-PSMA-11 (PSMA 11), and SOC imaging (a mix of bone scans, computed tomography, and magnetic resonance imaging) for the diagnosis and staging of prostate cancer from a US healthcare system perspective. PERSPECTIVE A US third-party payer perspective was used, which for this population reflects a mix of commercial and Medicare, considering only direct healthcare costs. SETTING This study utilized a tertiary healthcare setting. METHODS A decision tree was used to map the diagnostic/treatment pathway, consisting of the proportion of patients with local, regional, distant, or no disease; prostate-specific antigen (PSA) ≤ 1.0 or > 1.0; and accuracy of imaging modalities. A Markov model predicted the long-term outcomes of disease progression according to treatment decisions. Inputs to the model were informed by data from the OSPREY and CONDOR clinical trials, public data, and the literature. Treatment mix included active surveillance, radiation therapy, prostatectomy, androgen deprivation therapy (ADT), and radiation therapy + ADT, informed by expert opinion. Outcomes included life-years (LY), quality-adjusted life-years (QALY), and the incremental cost-effectiveness ratio (ICER). All costs were reported in 2021 US dollars, using the US Bureau of Labor Statistics Consumer Price Index. A willingness-to-pay (WTP) threshold of $150,000 was considered cost effective, consistent with the upper range used as the standard for price benchmarks by the Institute for Clinical and Economic Review. The robustness of the base-case results was assessed in deterministic and probabilistic sensitivity analyses. RESULTS Over a lifetime horizon, piflufolastat F 18 had the greatest effectiveness in terms of LYs (6.80) and QALYs (5.33); for the comparators, LYs ranged from 6.58 (SOC) to 6.76 (PSMA 11) and QALYs ranged from 5.12 (SOC) and 5.30 (PSMA 11). Piflufolastat F 18 was more cost effective compared with fluciclovine F 18, PSMA 11, and SOC, with ICERs of $21,122, $55,836, and $124,330 per QALY gained, respectively. Piflufolastat F 18 was associated with the greatest net monetary benefit ($627,918) compared with the other options at a WTP threshold of $150,000. The results of the deterministic and probabilistic sensitivity analyses supported the robustness of the base-case results. CONCLUSIONS This study suggests that piflufolastat F 18 is a cost-effective diagnostic option for men with prostate cancer in the US, with higher associated LY, QALY, and greater net monetary benefit than fluciclovine F 18, PSMA 11, and SOC imaging.
Collapse
|
2
|
Singh R, Alsayadi YMMA, Singh V, Chawla P, Rawal RK. Prospects of Treating Prostate Cancer through Apalutamide: A Mini-Review. Anticancer Agents Med Chem 2021; 22:1056-1067. [PMID: 34431470 DOI: 10.2174/1871520621666210824113736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prostate cancer is considered the second most diagnosed cancer, and one of the most common causes of death from cancer in men. Apalutamide is an effective, safe, and well-tolerated agent used for the treatment of men with non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic hormone-naive prostate cancer (mHNPC). Androgen receptor signaling is a leading factor that drives these prostate tumors. USFDA has approved apalutamide on 14 February 2018 as an agent that targets androgen receptor signaling through inhibition causing significant improvement in metastasis-free survival in patients with prostate cancer. <P> Objective: In this review, various aspects related to apalutamide have been summarized which involve the mechanism of action, chemistry, synthesis, pharmacokinetics, pharmacodynamics, adverse reactions, and safety parameters. <P> Methods: The literature was thoroughly searched in the relevant databases to identify studies published in this field during recent years. Special attention has been given to apalutamide clinical trials phases and its promising future as one of the first-line agents for the treatment of patients with advanced prostate cancer. <P> Results: Ongoing trials are progressing for apalutamide monotherapy and also for its combinations in other disease settings. The expected results of such trials will shape the future scenario of prostate cancer therapy. <P> Conclusion: This review article has highlighted different aspects of Apalutamide like its mechanism of action, adverse effects, pharmacokinetics, pharmacodynamics, clinical trials among others. The contents of this article should make an excellent read for prospective researchers in this field.
Collapse
Affiliation(s)
- Ranapartap Singh
- Department of Pharmaceutical Chemistry & Analysis, ISF College of Pharmacy, GT Road, Moga-142001, Punjab. India
| | - Yunes M M A Alsayadi
- Department of Pharmaceutical Chemistry & Analysis, ISF College of Pharmacy, GT Road, Moga-142001, Punjab. India
| | - VikramJeet Singh
- Department of Pharmaceutical Chemistry & Analysis, ISF College of Pharmacy, GT Road, Moga-142001, Punjab. India
| | - Pooja Chawla
- Department of Pharmaceutical Chemistry & Analysis, ISF College of Pharmacy, GT Road, Moga-142001, Punjab. India
| | - Ravindra Kumar Rawal
- Department of Chemistry, Maharishi Markandeshwar (Deemed to be University), Mullana-133207, Haryana. India
| |
Collapse
|
3
|
Villers A, Bessaoud F, Trétarre B, Grosclaude P, Malavaud B, Rebillard X, Iborra F, Daubisse L, Malavaud S, Roobol M, Heijnsdijk EA, de Koning HJ, Hugosson J, Rischmann P, Soulié M. Contamination in control group led to no effect of PSA-based screening on prostate cancer mortality at 9 years follow-up: Results of the French section of European Randomized Study of Screening for Prostate Cancer (ERSPC). Prog Urol 2020; 30:252-260. [PMID: 32197936 DOI: 10.1016/j.purol.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION European Randomized Study of Screening for Prostate Cancer (ERSPC) mortality results were reported for 7 European countries (excluding France) and showed a significant reduction in Prostate cancer (PCa) mortality. As those results have not been part of the global ERSPC results, it is of interest to report PCa mortality at a median follow-up of 9 years for French section of ERSPC. MATERIAL AND METHODS Two administrative departments were involved in the study. Only men after randomization in the screening group were invited by mail to be screened by PSA testing with two rounds at 4-6 year intervals. Biopsy was recommended if PSA>=3.0 ng/mL. No information other that the French Association of Urology recommandations on the use of PSA was offered to the control group (own decision of physicians and patients). Follow up was based on cancer registry database. Contamination defined as the receipt of PSA testing in control arm was measured. Poisson regression models were used to estimate the Rate Ratio (RR) of PCa mortality and incidence in the screening vs. control arm. RESULTS Starting from 2003, 80,696 men aged 55-69 years were included. The percentage of men in the screening arm with at least one PSA test (compliance) was 31%. Compared to the control arm, PCa incidence increased by 10% in the screening arm (RR=1.10; 95% CI=[1.04-1.16], P=0.001), but PCa mortality did not differ (0.222 and 0.215 deaths/1000 person-years; RR=1.03[0.75-1.42], P=0.9). DISCUSSION Limitations include low participation rate. PSA testing in the control arm was observed in 32% of men (contamination). CONCLUSIONS Contamination in control group led to no effect of PSA-based screening on prostate cancer mortality at 9 years follow-up. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- A Villers
- Department of Urology, University Lille, CHU Lille, Lille, France.
| | - F Bessaoud
- Hérault cancer registry, ICM Montpellier, Montpellier, France
| | - B Trétarre
- Hérault cancer registry, ICM Montpellier, Montpellier, France
| | | | - B Malavaud
- Department of Urology, University Toulouse, CHU Toulouse, Toulouse, France
| | - X Rebillard
- Department of Urology, Clinique Beau Soleil, Montpellier, France
| | - F Iborra
- Department of Urology, University Montpellier, CHU Montpellier, Montpellier, France
| | - L Daubisse
- Hérault cancer registry, ICM Montpellier, Montpellier, France
| | - S Malavaud
- Department of Public Health, University Toulouse, CHU Toulouse, Toulouse, France
| | - M Roobol
- Department of Urology, Erasmus University Medical center, Rotterdam, The Netherlands
| | - E A Heijnsdijk
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Göteborg, Göteborg, Sweden
| | - P Rischmann
- Department of Urology, University Toulouse, CHU Toulouse, Toulouse, France
| | - M Soulié
- Department of Urology, University Toulouse, CHU Toulouse, Toulouse, France
| |
Collapse
|
4
|
Luján M, Páez Á. Prostate-specific antigen screening for prostate cancer in males older than 75 years. Med Clin (Barc) 2019; 152:237-240. [PMID: 30220470 DOI: 10.1016/j.medcli.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Marcos Luján
- Unidad de Urología, Hospital Universitario Infanta Cristina, Parla, Universidad Complutense de Madrid, Madrid, España.
| | - Álvaro Páez
- Servicio de Urología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
| |
Collapse
|
5
|
A 16-yr Follow-up of the European Randomized study of Screening for Prostate Cancer. Eur Urol 2019; 76:43-51. [PMID: 30824296 DOI: 10.1016/j.eururo.2019.02.009] [Citation(s) in RCA: 350] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 02/07/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The European Randomized study of Screening for Prostate Cancer (ERSPC) has previously demonstrated that prostate-specific antigen (PSA) screening decreases prostate cancer (PCa) mortality. OBJECTIVE To determine whether PSA screening decreases PCa mortality for up to 16yr and to assess results following adjustment for nonparticipation and the number of screening rounds attended. DESIGN, SETTING, AND PARTICIPANTS This multicentre population-based randomised screening trial was conducted in eight European countries. Report includes 182160 men, followed up until 2014 (maximum of 16yr), with a predefined core age group of 162389 men (55-69yr), selected from population registry. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The outcome was PCa mortality, also assessed with adjustment for nonparticipation and the number of screening rounds attended. RESULTS AND LIMITATIONS The rate ratio of PCa mortality was 0.80 (95% confidence interval [CI] 0.72-0.89, p<0.001) at 16yr. The difference in absolute PCa mortality increased from 0.14% at 13yr to 0.18% at 16yr. The number of men needed to be invited for screening to prevent one PCa death was 570 at 16yr compared with 742 at 13yr. The number needed to diagnose was reduced to 18 from 26 at 13yr. Men with PCa detected during the first round had a higher prevalence of PSA >20ng/ml (9.9% compared with 4.1% in the second round, p<0.001) and higher PCa mortality (hazard ratio=1.86, p<0.001) than those detected subsequently. CONCLUSIONS Findings corroborate earlier results that PSA screening significantly reduces PCa mortality, showing larger absolute benefit with longer follow-up and a reduction in excess incidence. Repeated screening may be important to reduce PCa mortality on a population level. PATIENT SUMMARY In this report, we looked at the outcomes from prostate cancer in a large European population. We found that repeated screening reduces the risk of dying from prostate cancer.
Collapse
|
6
|
Martin RM, Donovan JL, Turner EL, Metcalfe C, Young GJ, Walsh EI, Lane JA, Noble S, Oliver SE, Evans S, Sterne JAC, Holding P, Ben-Shlomo Y, Brindle P, Williams NJ, Hill EM, Ng SY, Toole J, Tazewell MK, Hughes LJ, Davies CF, Thorn JC, Down E, Davey Smith G, Neal DE, Hamdy FC. Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality: The CAP Randomized Clinical Trial. JAMA 2018; 319:883-895. [PMID: 29509864 PMCID: PMC5885905 DOI: 10.1001/jama.2018.0154] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/17/2018] [Indexed: 11/14/2022]
Abstract
Importance Prostate cancer screening remains controversial because potential mortality or quality-of-life benefits may be outweighed by harms from overdetection and overtreatment. Objective To evaluate the effect of a single prostate-specific antigen (PSA) screening intervention and standardized diagnostic pathway on prostate cancer-specific mortality. Design, Setting, and Participants The Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP) included 419 582 men aged 50 to 69 years and was conducted at 573 primary care practices across the United Kingdom. Randomization and recruitment of the practices occurred between 2001 and 2009; patient follow-up ended on March 31, 2016. Intervention An invitation to attend a PSA testing clinic and receive a single PSA test vs standard (unscreened) practice. Main Outcomes and Measures Primary outcome: prostate cancer-specific mortality at a median follow-up of 10 years. Prespecified secondary outcomes: diagnostic cancer stage and Gleason grade (range, 2-10; higher scores indicate a poorer prognosis) of prostate cancers identified, all-cause mortality, and an instrumental variable analysis estimating the causal effect of attending the PSA screening clinic. Results Among 415 357 randomized men (mean [SD] age, 59.0 [5.6] years), 189 386 in the intervention group and 219 439 in the control group were included in the analysis (n = 408 825; 98%). In the intervention group, 75 707 (40%) attended the PSA testing clinic and 67 313 (36%) underwent PSA testing. Of 64 436 with a valid PSA test result, 6857 (11%) had a PSA level between 3 ng/mL and 19.9 ng/mL, of whom 5850 (85%) had a prostate biopsy. After a median follow-up of 10 years, 549 (0.30 per 1000 person-years) died of prostate cancer in the intervention group vs 647 (0.31 per 1000 person-years) in the control group (rate difference, -0.013 per 1000 person-years [95% CI, -0.047 to 0.022]; rate ratio [RR], 0.96 [95% CI, 0.85 to 1.08]; P = .50). The number diagnosed with prostate cancer was higher in the intervention group (n = 8054; 4.3%) than in the control group (n = 7853; 3.6%) (RR, 1.19 [95% CI, 1.14 to 1.25]; P < .001). More prostate cancer tumors with a Gleason grade of 6 or lower were identified in the intervention group (n = 3263/189 386 [1.7%]) than in the control group (n = 2440/219 439 [1.1%]) (difference per 1000 men, 6.11 [95% CI, 5.38 to 6.84]; P < .001). In the analysis of all-cause mortality, there were 25 459 deaths in the intervention group vs 28 306 deaths in the control group (RR, 0.99 [95% CI, 0.94 to 1.03]; P = .49). In the instrumental variable analysis for prostate cancer mortality, the adherence-adjusted causal RR was 0.93 (95% CI, 0.67 to 1.29; P = .66). Conclusions and Relevance Among practices randomized to a single PSA screening intervention vs standard practice without screening, there was no significant difference in prostate cancer mortality after a median follow-up of 10 years but the detection of low-risk prostate cancer cases increased. Although longer-term follow-up is under way, the findings do not support single PSA testing for population-based screening. Trial Registration ISRCTN Identifier: ISRCTN92187251.
Collapse
Affiliation(s)
- Richard M. Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, England
| | - Jenny L. Donovan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Trust, Bristol, England
| | - Emma L. Turner
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Chris Metcalfe
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, England
| | - Grace J. Young
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, England
| | - Eleanor I. Walsh
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - J. Athene Lane
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, England
| | - Sian Noble
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Steven E. Oliver
- Department of Health Sciences, University of York and Hull York Medical School, York, England
| | - Simon Evans
- Urology Department, Royal United Hospital, Bath, England
| | - Jonathan A. C. Sterne
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, England
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Trust, Bristol, England
| | - Peter Brindle
- Bristol, North Somerset, and South Gloucestershire Clinical Commissioning Group, Bristol, England
| | - Naomi J. Williams
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Elizabeth M. Hill
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Siaw Yein Ng
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Jessica Toole
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Marta K. Tazewell
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Laura J. Hughes
- Department of Oncology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, England
| | - Charlotte F. Davies
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Joanna C. Thorn
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Elizabeth Down
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - George Davey Smith
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, England
| | - David E. Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
- Department of Oncology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, England
| | - Freddie C. Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
| |
Collapse
|
7
|
Luján M, Páez Á, Angulo JC, Granados R, Nevado M, Torres GM, Berenguer A. Long-term prostate-specific antigen contamination in the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Actas Urol Esp 2016; 40:164-72. [PMID: 26620123 DOI: 10.1016/j.acuro.2015.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/11/2015] [Accepted: 10/13/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Recently, the European Randomized Study of Screening for Prostate Cancer achieved a reduction in prostate cancer mortality by measuring serum prostate-specific antigen (PSA) levels. These results were not reproduced in the Spanish arm of European Randomized Study of Screening for Prostate Cancer. PSA contamination (opportunistic measurements outside the study) could decrease the study's contrasting power if performed in the control arm. We have calculated the long-term rate of PSA contamination and its effect on performing prostate biopsy and detecting cancer. MATERIAL AND METHODS A total of 4,276 men were randomised (2,415 to the screening arm, 1,861 to the control arm) in the Spanish section of the European Randomized Study of Screening for Prostate Cancer. PSA measurements were not scheduled in the control arm. Sextant prostate biopsy was indicated if PSA levels were ≥3 ng/mL. All PSA readings performed outside the study were labelled as "PSA contamination". We calculated the rates of PSA contamination, biopsy implementation and cancer detection. RESULTS The median age and follow-up time were 57 and 15.1 years, respectively. A total of 2,511 men underwent at least one PSA reading outside the study. PSA contamination at 5, 10 and 15 years was 22.0%, 47.1% and 66.3% in the screening arm, respectively, and 20.8%, 43.2% and 58.6% in the control arm, respectively (P<.0001). The biopsy rate at 5, 10 and 15 years was 19.3%, 22.6% and 24.1% (screening), respectively, and 1.0%, 3.6% and 7.1% (control), respectively (P<.0001). The PC detection rate was 6.7% (screening) and 4.3% (control; P=.0006). CONCLUSIONS Although the cumulative PSA contamination was pronounced in the 2 study arms, the rate of prostate biopsies was low in the control arm. We therefore believe that the effect of PSA contamination on the study's statistical power should be limited.
Collapse
Affiliation(s)
- M Luján
- Unidad de Urología, Hospital Universitario Infanta Cristina, Universidad Complutense de Madrid, Madrid, España.
| | - Á Páez
- Servicio de Urología. Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
| | - J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España
| | - R Granados
- Servicio de Anatomía Patológica, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España
| | - M Nevado
- Unidad de Anatomía Patológica, Hospital Universitario Infanta Cristina, Universidad Complutense de Madrid, Madrid, España
| | - G M Torres
- Unidad de Urología, Hospital Universitario de Torrejón, Madrid, España
| | - A Berenguer
- Servicio de Urología, Hospital Universitario de Madrid-Norte Sanchinarro, Universidad San Pablo-CEU, Madrid, España
| |
Collapse
|
8
|
Schröder FH, Hugosson J, Roobol MJ, Tammela TLJ, Zappa M, Nelen V, Kwiatkowski M, Lujan M, Määttänen L, Lilja H, Denis LJ, Recker F, Paez A, Bangma CH, Carlsson S, Puliti D, Villers A, Rebillard X, Hakama M, Stenman UH, Kujala P, Taari K, Aus G, Huber A, van der Kwast TH, van Schaik RHN, de Koning HJ, Moss SM, Auvinen A. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet 2014; 384:2027-35. [PMID: 25108889 PMCID: PMC4427906 DOI: 10.1016/s0140-6736(14)60525-0] [Citation(s) in RCA: 1028] [Impact Index Per Article: 102.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The European Randomised study of Screening for Prostate Cancer (ERSPC) has shown significant reductions in prostate cancer mortality after 9 years and 11 years of follow-up, but screening is controversial because of adverse events such as overdiagnosis. We provide updated results of mortality from prostate cancer with follow-up to 2010, with analyses truncated at 9, 11, and 13 years. METHODS ERSPC is a multicentre, randomised trial with a predefined centralised database, analysis plan, and core age group (55-69 years), which assesses prostate-specific antigen (PSA) testing in eight European countries. Eligible men aged 50-74 years were identified from population registries and randomly assigned by computer generated random numbers to screening or no intervention (control). Investigators were masked to group allocation. The primary outcome was prostate cancer mortality in the core age group. Analysis was by intention to treat. We did a secondary analysis that corrected for selection bias due to non-participation. Only incidence and no mortality data at 9 years' follow-up are reported for the French centres. This study is registered with Current Controlled Trials, number ISRCTN49127736. FINDINGS With data truncated at 13 years of follow-up, 7408 prostate cancer cases were diagnosed in the intervention group and 6107 cases in the control group. The rate ratio of prostate cancer incidence between the intervention and control groups was 1·91 (95% CI 1·83-1·99) after 9 years (1·64 [1·58-1·69] including France), 1·66 (1·60-1·73) after 11 years, and 1·57 (1·51-1·62) after 13 years. The rate ratio of prostate cancer mortality was 0·85 (0·70-1·03) after 9 years, 0·78 (0·66-0·91) after 11 years, and 0·79 (0·69-0·91) at 13 years. The absolute risk reduction of death from prostate cancer at 13 years was 0·11 per 1000 person-years or 1·28 per 1000 men randomised, which is equivalent to one prostate cancer death averted per 781 (95% CI 490-1929) men invited for screening or one per 27 (17-66) additional prostate cancer detected. After adjustment for non-participation, the rate ratio of prostate cancer mortality in men screened was 0·73 (95% CI 0·61-0·88). INTERPRETATION In this update the ERSPC confirms a substantial reduction in prostate cancer mortality attributable to testing of PSA, with a substantially increased absolute effect at 13 years compared with findings after 9 and 11 years. Despite our findings, further quantification of harms and their reduction are still considered a prerequisite for the introduction of populated-based screening. FUNDING Each centre had its own funding responsibility.
Collapse
Affiliation(s)
- Fritz H Schröder
- Department of Urology, Erasmus University Medical Center, Rotterdam, Netherlands.
| | - Jonas Hugosson
- Department of Urology, Sahlgrenska Academy at Goteborg University, Goteborg, Sweden
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Teuvo L J Tammela
- Department of Urology, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland
| | - Marco Zappa
- Unit of Clinical and Descriptive Epidemiology, ISPO, Florence, Italy
| | - Vera Nelen
- Provinciaal Instituut voor Hygiene, Antwerp, Belgium
| | - Maciej Kwiatkowski
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland; Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Marcos Lujan
- Department of Urology, Hospital Infanta Cristina, Parla, Madrid, Spain; Department of Urology, Hospital Universitario de Getafe, Getafe, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | | | - Hans Lilja
- Department of Surgery (Urology), Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Departments of Laboratory Medicine and Medicine (GU-Oncology), Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Laboratory Medicine, Lund University, Malmö, Sweden; Institute of Biomedical Technology, University of Tampere, Tampere, Finland
| | | | - Franz Recker
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland
| | - Alvaro Paez
- Department of Urology, Hospital Universitario de Fuenlabrada, Madrid, Spain; Department of Urology, Hospital Universitario de Getafe, Getafe, Madrid, Spain; Universidad Rey Juan Carlos, Madrid, Spain
| | - Chris H Bangma
- Department of Urology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sigrid Carlsson
- Department of Urology, Sahlgrenska Academy at Goteborg University, Goteborg, Sweden; Department of Surgery (Urology), Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Donella Puliti
- Unit of Clinical and Descriptive Epidemiology, ISPO, Florence, Italy
| | - Arnauld Villers
- Department of Urology, CHU Lille, Univ Lille Nord de France, Lille, France
| | | | - Matti Hakama
- Finnish Cancer Registry, Helsinki, Finland; School of Health Sciences, University of Tampere, Tampere, Finland
| | - Ulf-Hakan Stenman
- Department of Clinical Chemistry, Helsinki University Central Hospital Laboratory Division (HUSLAB), Helsinki, Finland
| | - Paula Kujala
- FIMLAB, Department of Pathology, Tampere, Finland
| | - Kimmo Taari
- Department of Urology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Gunnar Aus
- Department of Urology, Carlanderska Sjukhuset Göteborg, Sweden
| | - Andreas Huber
- Centre of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Theo H van der Kwast
- Department of Pathology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sue M Moss
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Anssi Auvinen
- School of Health Sciences, University of Tampere, Tampere, Finland
| |
Collapse
|
9
|
Fornara P, Theil G, Schaefer C, Heß J, Rübben H. Benefits and Risks of Prostate Cancer Screening. Oncol Res Treat 2014; 37 Suppl 3:29-37. [DOI: 10.1159/000363756] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
10
|
Turner EL, Metcalfe C, Donovan JL, Noble S, Sterne JAC, Lane JA, Avery KN, Down L, Walsh E, Davis M, Ben-Shlomo Y, Oliver SE, Evans S, Brindle P, Williams NJ, Hughes LJ, Hill EM, Davies C, Ng SY, Neal DE, Hamdy FC, Martin RM. Design and preliminary recruitment results of the Cluster randomised triAl of PSA testing for Prostate cancer (CAP). Br J Cancer 2014; 110:2829-36. [PMID: 24867688 PMCID: PMC4056057 DOI: 10.1038/bjc.2014.242] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 04/08/2014] [Accepted: 04/10/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Screening for prostate cancer continues to generate controversy because of concerns about over-diagnosis and unnecessary treatment. We describe the rationale, design and recruitment of the Cluster randomised triAl of PSA testing for Prostate cancer (CAP) trial, a UK-wide cluster randomised controlled trial investigating the effectiveness and cost-effectiveness of prostate-specific antigen (PSA) testing. METHODS Seven hundred and eighty-five general practitioner (GP) practices in England and Wales were randomised to a population-based PSA testing or standard care and then approached for consent to participate. In the intervention arm, men aged 50-69 years were invited to undergo PSA testing, and those diagnosed with localised prostate cancer were invited into a treatment trial. Control arm practices undertook standard UK management. All men were flagged with the Health and Social Care Information Centre for deaths and cancer registrations. The primary outcome is prostate cancer mortality at a median 10-year-follow-up. RESULTS Among randomised practices, 271 (68%) in the intervention arm (198,114 men) and 302 (78%) in the control arm (221,929 men) consented to participate, meeting pre-specified power requirements. There was little evidence of differences between trial arms in measured baseline characteristics of the consenting GP practices (or men within those practices). CONCLUSIONS The CAP trial successfully met its recruitment targets and will make an important contribution to international understanding of PSA-based prostate cancer screening.
Collapse
Affiliation(s)
- E L Turner
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - C Metcalfe
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - J L Donovan
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - S Noble
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - J A C Sterne
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - J A Lane
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - K N Avery
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - L Down
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - E Walsh
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - M Davis
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Y Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - S E Oliver
- Department of Health Sciences, University of York and the Hull York Medical School, York YO10 5DD, UK
| | - S Evans
- Royal United Hospital Bath, Combe Park, Bath BA1 3NG, UK
| | - P Brindle
- Avon Primary Care Research Collaborative, Marlborough Street, South Plaza, Bristol BS1 3NX, UK
| | - N J Williams
- School of Social and Community Medicine, University of Bristol, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - L J Hughes
- Department of Oncology, University of Cambridge, Box 279 (S4), Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - E M Hill
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - C Davies
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - S Y Ng
- School of Social and Community Medicine, University of Bristol, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - D E Neal
- Department of Oncology, University of Cambridge, Box 279 (S4), Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - F C Hamdy
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - R M Martin
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- MRC/University of Bristol Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - the CAP trial group
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- Department of Health Sciences, University of York and the Hull York Medical School, York YO10 5DD, UK
- Royal United Hospital Bath, Combe Park, Bath BA1 3NG, UK
- Avon Primary Care Research Collaborative, Marlborough Street, South Plaza, Bristol BS1 3NX, UK
- School of Social and Community Medicine, University of Bristol, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
- Department of Oncology, University of Cambridge, Box 279 (S4), Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
- School of Social and Community Medicine, University of Bristol, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, UK
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford OX3 9DU, UK
- MRC/University of Bristol Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| |
Collapse
|
11
|
Luján M, Páez A, Angulo JC, Granados R, Nevado M, Torres GM, Berenguer A. Prostate cancer incidence and mortality in the Spanish section of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Prostate Cancer Prostatic Dis 2014; 17:187-91. [PMID: 24614694 DOI: 10.1038/pcan.2014.7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 01/13/2014] [Accepted: 01/26/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND To present the long-term results of a prostate cancer (PC) screening trial conducted in a Mediterranean setting. METHODS A total of 4276 men aged 45-70 years were randomized to screening arm (PSA test performed) and control arm (no tests). Transrectal ultrasonography-guided sextant prostate biopsy was conducted when PSA > or = 3 ng ml(-1). Date and cause of death were retrieved from death certificates. PC incidence, and disease-specific and overall mortality curves were plotted and comparison between arms was made. Analysis of causes of death was also performed. RESULTS Median age at randomization was 57.0 years. Median follow-up time was 15.2 years. A total of 241 men were diagnosed with PC, 161 (6.7%) in the screening arm and 80 (4.3%) in the control arm (P<0.01). Eventually, 554 men (13%) died. No difference in all-cause mortality was found between arms (P=0.34). Only 10 men (10/4276, 0.23%) died from PC, no differences between arms (P=0.67). Overall, the main causes of death were malignancy (54.2%), cardiovascular (17.9%) and respiratory (9.2%) diseases. Main cancer causes of death were lung and bronchus cancer (37.2%), colorectum (15.0%) and stomach (9.0%) cancer. PC only accounted for 3.0% of all malignant causes of death (ranked 10th). CONCLUSIONS Our study failed to demonstrate benefits of PC screening in terms of all-cause and PC-specific mortality after a median follow-up of 15 years. The limited sample size and the low long-term PC mortality observed in our setting were probably the most important factors to explain these results.
Collapse
Affiliation(s)
- M Luján
- Department of Urology, Hospital Universitario Infanta Cristina, Universidad Complutense de Madrid, Madrid, Spain
| | - A Páez
- Department of Urology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - J C Angulo
- Department of Urology, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain
| | - R Granados
- Department of Pathology, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain
| | - M Nevado
- Department of Pathology, Universitario Infanta Cristina, Universidad Complutense de Madrid, Madrid, Spain
| | - G M Torres
- Department of Urology, Hospital Universitario de Torrejón, Madrid, Spain
| | - A Berenguer
- Department of Urology, Hospital Universitario Madrid Norte Sanchinarro, Universidad San Pablo CEU, Madrid, Spain
| |
Collapse
|
12
|
Etzioni R. Impact of prostate-specific antigen screening: building confidence. Eur Urol 2014; 66:404-5. [PMID: 24576500 DOI: 10.1016/j.eururo.2014.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Ruth Etzioni
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| |
Collapse
|
13
|
[Early detection of prostate cancer: harm verified, benefit not verifiable]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:318-26. [PMID: 24562707 DOI: 10.1007/s00103-013-1904-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The results of randomized studies on the early detection of prostate cancer and those of a systematic Cochrane review are compiled and interpreted. Some fundamental and inherent weaknesses of screening studies are pointed out and discussed. The meta-analysis of studies involving a total of 321,594 participants shows no reduction in prostate cancer mortality or all-cause mortality, but describes disadvantages such as unnecessary biopsies, overdiagnosis, and overtreatment. A relevant increase in overall mortality cannot be excluded. Even in future trials, the possible reduction of prostate cancer mortality or all-cause mortality by prostate cancer screening will not be detectable because of inherent methodological problems, e.g., an extremely high number of participants are needed. Furthermore, by nature, studies on the early detection of cancer last very long, such that the results are inevitably outdated at the end of the study. There is a risk that studies on the early detection of cancer suggest an advantage and at the same time overlook a relevant increase in overall mortality. Prostate cancer screening also ignores important WHO criteria for screening programs: There is evidence that early treatment of prostate cancer is not better than late treatment. There is no suitable or reliable test to identify the early stages of the disease. The benefit-risk ratio is not clearly favorable, and there is doubt whether the costs and the benefits are in an acceptable balance. There are valid reasons to advise against population-based prostate cancer screening.
Collapse
|
14
|
Field JK, van Klaveren R, Pedersen JH, Pastorino U, Paci E, Becker N, Infante M, Oudkerk M, de Koning HJ. European randomized lung cancer screening trials: Post NLST. J Surg Oncol 2013; 108:280-6. [DOI: 10.1002/jso.23383] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 05/28/2013] [Indexed: 01/27/2023]
Affiliation(s)
- John K. Field
- The University of Liverpool Cancer Research Centre; Liverpool UK
| | | | - Jesper H. Pedersen
- Department of Thoracic Surgery; University of Copenhagen; Copenhagen Denmark
| | - Ugo Pastorino
- Department of Thoracic Surgery; European Institute of Oncology; Milan Italy
| | - Eugino Paci
- Unit of Clinical and Descriptive Epidemiology; ISPO; Florence Italy
| | - Nikolauss Becker
- Division of Cancer Epidemiology; German Cancer Research Center; Heidelberg Germany
| | - Maurizo Infante
- Department of Thoracic Surgery; Instituto Clinico Humanitas; Milan Italy
| | - Matthijs Oudkerk
- Center for Medical Imaging; University Medical Center Groningen; Netherlands
| | | | | |
Collapse
|
15
|
Labrie F. PSA screening for prostate cancer: why so much controversy? Asian J Androl 2013; 15:603-7. [PMID: 23770941 DOI: 10.1038/aja.2013.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/03/2013] [Accepted: 01/26/2013] [Indexed: 12/21/2022] Open
Abstract
Since prostate cancer reaches the advanced and non curable stage in the absence of any specific symptom or sign, it seems reasonable to diagnose this cancer at an early and curable stage. Screening by prostate-specific antigen (PSA) has been the common technology used. The last follow-up of the first two prospective and randomized screening studies for prostate cancer, namely the Quebec and ERSPC (European Randomized Study of Screening for Prostate Cancer) clinical trials started in 1988 and 1991, respectively, have shown reductions of prostate cancer death of 62% (P<0.002) and 21% (P<0.001) (38% in the tenth and eleventh years of follow-up, P<0.003), respectively, while the PLCO (Prostate Lung Colorectal and Ovarian Cancer) screening trial reported no benefit. It has been estimated, however, that 85% of men in the planned 'non-screened' group of the US study have been screened. With such a serious flaw, the PLCO study does not have the statistical power to reach any valid conclusion. In the Quebec study, only 7.3% of men were screened in the control arm. The important benefit observed in the ERSPC study was achieved using a less than optimal 4-year PSA screening interval which misses a significant number of cancers while the Quebec study used the optimal 1-year interval. With proper information obtained from their physicians or otherwise using data collected only from the clinical trials having the required statistical power, men should be in a good position to decide about being or not being screened for prostate cancer.
Collapse
|
16
|
Kilpelainen TP, Tammela TL, Malila N, Hakama M, Santti H, Maattanen L, Stenman UH, Kujala P, Auvinen A. Prostate Cancer Mortality in the Finnish Randomized Screening Trial. J Natl Cancer Inst 2013; 105:719-25. [DOI: 10.1093/jnci/djt038] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
|
17
|
Abstract
BACKGROUND Any form of screening aims to reduce disease-specific and overall mortality, and to improve a person's future quality of life. Screening for prostate cancer has generated considerable debate within the medical and broader community, as demonstrated by the varying recommendations made by medical organizations and governed by national policies. To better inform individual patient decision-making and health policy decisions, we need to consider the entire body of data from randomised controlled trials (RCTs) on prostate cancer screening summarised in a systematic review. In 2006, our Cochrane review identified insufficient evidence to either support or refute the use of routine mass, selective, or opportunistic screening for prostate cancer. An update of the review in 2010 included three additional trials. Meta-analysis of the five studies included in the 2010 review concluded that screening did not significantly reduce prostate cancer-specific mortality. In the past two years, several updates to studies included in the 2010 review have been published thereby providing the rationale for this update of the 2010 systematic review. OBJECTIVES To determine whether screening for prostate cancer reduces prostate cancer-specific mortality or all-cause mortality and to assess its impact on quality of life and adverse events. SEARCH METHODS An updated search of electronic databases (PROSTATE register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CANCERLIT, and the NHS EED) was performed, in addition to handsearching of specific journals and bibliographies, in an effort to identify both published and unpublished trials. SELECTION CRITERIA All RCTs of screening versus no screening for prostate cancer were eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS The original search (2006) identified 99 potentially relevant articles that were selected for full-text review. From these citations, two RCTs were identified as meeting the inclusion criteria. The search for the 2010 version of the review identified a further 106 potentially relevant articles, from which three new RCTs were included in the review. A total of 31 articles were retrieved for full-text examination based on the updated search in 2012. Updated data on three studies were included in this review. Data from the trials were independently extracted by two authors. MAIN RESULTS Five RCTs with a total of 341,342 participants were included in this review. All involved prostate-specific antigen (PSA) testing, with or without digital rectal examination (DRE), though the interval and threshold for further evaluation varied across trials. The age of participants ranged from 45 to 80 years and duration of follow-up from 7 to 20 years. Our meta-analysis of the five included studies indicated no statistically significant difference in prostate cancer-specific mortality between men randomised to the screening and control groups (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.86 to 1.17). The methodological quality of three of the studies was assessed as posing a high risk of bias. The European Randomized Study of Screening for Prostate Cancer (ERSPC) and the US Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial were assessed as posing a low risk of bias, but provided contradicting results. The ERSPC study reported a significant reduction in prostate cancer-specific mortality (RR 0.84, 95% CI 0.73 to 0.95), whilst the PLCO study concluded no significant benefit (RR 1.15, 95% CI 0.86 to 1.54). The ERSPC was the only study of the five included in this review that reported a significant reduction in prostate cancer-specific mortality, in a pre-specified subgroup of men aged 55 to 69 years of age. Sensitivity analysis for overall risk of bias indicated no significant difference in prostate cancer-specific mortality when referring to the meta analysis of only the ERSPC and PLCO trial data (RR 0.96, 95% CI 0.70 to 1.30). Subgroup analyses indicated that prostate cancer-specific mortality was not affected by the age at which participants were screened. Meta-analysis of four studies investigating all-cause mortality did not determine any significant differences between men randomised to screening or control (RR 1.00, 95% CI 0.96 to 1.03). A diagnosis of prostate cancer was significantly greater in men randomised to screening compared to those randomised to control (RR 1.30, 95% CI 1.02 to 1.65). Localised prostate cancer was more commonly diagnosed in men randomised to screening (RR 1.79, 95% CI 1.19 to 2.70), whilst the proportion of men diagnosed with advanced prostate cancer was significantly lower in the screening group compared to the men serving as controls (RR 0.80, 95% CI 0.73 to 0.87). Screening resulted in a range of harms that can be considered minor to major in severity and duration. Common minor harms from screening include bleeding, bruising and short-term anxiety. Common major harms include overdiagnosis and overtreatment, including infection, blood loss requiring transfusion, pneumonia, erectile dysfunction, and incontinence. Harms of screening included false-positive results for the PSA test and overdiagnosis (up to 50% in the ERSPC study). Adverse events associated with transrectal ultrasound (TRUS)-guided biopsies included infection, bleeding and pain. No deaths were attributed to any biopsy procedure. None of the studies provided detailed assessment of the effect of screening on quality of life or provided a comprehensive assessment of resource utilization associated with screening (although preliminary analyses were reported). AUTHORS' CONCLUSIONS Prostate cancer screening did not significantly decrease prostate cancer-specific mortality in a combined meta-analysis of five RCTs. Only one study (ERSPC) reported a 21% significant reduction of prostate cancer-specific mortality in a pre-specified subgroup of men aged 55 to 69 years. Pooled data currently demonstrates no significant reduction in prostate cancer-specific and overall mortality. Harms associated with PSA-based screening and subsequent diagnostic evaluations are frequent, and moderate in severity. Overdiagnosis and overtreatment are common and are associated with treatment-related harms. Men should be informed of this and the demonstrated adverse effects when they are deciding whether or not to undertake screening for prostate cancer. Any reduction in prostate cancer-specific mortality may take up to 10 years to accrue; therefore, men who have a life expectancy less than 10 to 15 years should be informed that screening for prostate cancer is unlikely to be beneficial. No studies examined the independent role of screening by DRE.
Collapse
Affiliation(s)
- Dragan Ilic
- Department of Epidemiology&PreventiveMedicine, School of PublicHealth&PreventiveMedicine,MonashUniversity,Melbourne,Australia.
| | | | | | | |
Collapse
|
18
|
Luján M, Páez Á, Berenguer A, Rodríguez J. [Mortality due to prostate cancer in the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Results after a 15-year follow-up]. Actas Urol Esp 2012; 36:403-9. [PMID: 22269382 DOI: 10.1016/j.acuro.2011.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To address if prostate cancer (PCa) screening decreases PCa mortality in the asymptomatic population, within the setting of the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). MATERIAL AND METHODS From 1996 to 1999, 4,278 men aged 45-70 years were recruited and randomized to the screening arm (PSA every 4 years, prostate biopsy when PSA ≥3 ng/ml) and control arm (no tests). Dates and causes of death were collected on an annual basis. A Kaplan-Meier analysis was used to calculate overall and cancer-specific survival. RESULTS A total of 2,416 men were recruited in the screening arm and 1,862 in the control arm. Mean age was 57.8 years, median follow-up was 13.3 years. At the end of the follow-up period, 427 deaths (9 from PCa) were observed. Survival analysis did not show any difference between the study arms with respect to overall and cancer-specific survival (p=0.939 and p=0.544 respectively). Most relevant causes of death were malignant tumors (52.9%), cardiovascular disease (17.3%) and respiratory (8.9%). Only 2.1% of deaths (0.2% of all recruited men) were due to PCa (2.5% screening, 1.6% control). CONCLUSIONS The Spanish arm of ERSPC failed to reproduce the long-term results shown in the whole study. No differences in mortality (overall or cancer-specific) were observed after 15 years of follow-up. PCa mortality was infrequent (less than 1%). These results suggest limited yield of PCa screening in our setting.
Collapse
|
19
|
Schröder FH, Hugosson J, Roobol MJ, Tammela TLJ, Ciatto S, Nelen V, Kwiatkowski M, Lujan M, Lilja H, Zappa M, Denis LJ, Recker F, Páez A, Määttänen L, Bangma CH, Aus G, Carlsson S, Villers A, Rebillard X, van der Kwast T, Kujala PM, Blijenberg BG, Stenman UH, Huber A, Taari K, Hakama M, Moss SM, de Koning HJ, Auvinen A. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med 2012; 366:981-90. [PMID: 22417251 PMCID: PMC6027585 DOI: 10.1056/nejmoa1113135] [Citation(s) in RCA: 866] [Impact Index Per Article: 72.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Several trials evaluating the effect of prostate-specific antigen (PSA) testing on prostate-cancer mortality have shown conflicting results. We updated prostate-cancer mortality in the European Randomized Study of Screening for Prostate Cancer with 2 additional years of follow-up. METHODS The study involved 182,160 men between the ages of 50 and 74 years at entry, with a predefined core age group of 162,388 men 55 to 69 years of age. The trial was conducted in eight European countries. Men who were randomly assigned to the screening group were offered PSA-based screening, whereas those in the control group were not offered such screening. The primary outcome was mortality from prostate cancer. RESULTS After a median follow-up of 11 years in the core age group, the relative reduction in the risk of death from prostate cancer in the screening group was 21% (rate ratio, 0.79; 95% confidence interval [CI], 0.68 to 0.91; P=0.001), and 29% after adjustment for noncompliance. The absolute reduction in mortality in the screening group was 0.10 deaths per 1000 person-years or 1.07 deaths per 1000 men who underwent randomization. The rate ratio for death from prostate cancer during follow-up years 10 and 11 was 0.62 (95% CI, 0.45 to 0.85; P=0.003). To prevent one death from prostate cancer at 11 years of follow-up, 1055 men would need to be invited for screening and 37 cancers would need to be detected. There was no significant between-group difference in all-cause mortality. CONCLUSIONS Analyses after 2 additional years of follow-up consolidated our previous finding that PSA-based screening significantly reduced mortality from prostate cancer but did not affect all-cause mortality. (Current Controlled Trials number, ISRCTN49127736.).
Collapse
Affiliation(s)
- Fritz H Schröder
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Kwiatkowski M, Klotz L, Hugosson J, Recker F. Comment on the US Preventive Services Task Force's draft recommendation on screening for prostate cancer. Eur Urol 2012; 61:851-4. [PMID: 22285762 DOI: 10.1016/j.eururo.2012.01.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 01/16/2012] [Indexed: 10/14/2022]
|
21
|
Schröder FH. Screening for prostate cancer. Eur J Cancer 2011; 47 Suppl 3:S164-70. [DOI: 10.1016/s0959-8049(11)70160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
22
|
van Leeuwen PJ, Kranse R, Hakulinen T, Roobol MJ, de Koning HJ, Bangma CH, Schröder FH. Disease-specific mortality may underestimate the total effect of prostate cancer screening. J Med Screen 2011; 17:204-10. [PMID: 21258131 DOI: 10.1258/jms.2010.010074] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To study the difference between the disease-specific and excess mortality rate in the European Randomized Study of Screening for Prostate Cancer section Rotterdam. METHODS A total of 42,376 men were randomized to systematic screening or usual care. The excess number of deaths was defined as the difference between the observed number of deaths in the prostate cancer (PC) patients and the expected number of deaths up to 31 December 2006. The expected number was derived from mortality of all study participants before a possible diagnosis with PC. The disease-specific mortality rate was based on the number of men who died from PC. The excess mortality rate based on the arm-specific excess number of deaths and the disease-specific mortality rate were compared between the two study arms. RESULTS The overall mortality rate was not significantly different between the intervention and the control arms of the study: RR 1.02 (95% CI 0.98-1.07). The disease-specific mortality rate was 0.42 men per 1000 person-years in the intervention and 0.48 men per 1000 person-years in the control arm: RR 0.86 (95% CI 0.64-1.17). The excess mortality rate was 0.40 per 1000 person-years in the intervention arm and 0.61 men per 1000 person-years in the control arm, and the RR for excess mortality was 0.66 (95% CI 0.39-1.13). CONCLUSIONS In contrast to the disease-specific mortality rates an increased difference in the excess mortality rates was observed between the two arms. This observation may be due to a systematic underestimation of the disease-specific deaths, and/or an additional disease-related mortality that is measured by an excess mortality analysis but not by a disease-specific mortality.
Collapse
|
23
|
Pogodin-Hannolainen D, Juusela H, Tammela TLJ, Ruutu M, Aro J, Määttänen L, Auvinen A. Prostate Cancer Screening: A Survey of Attitudes and Practices among Finnish Physicians in 1999 and 2007. J Med Screen 2011; 18:46-9. [DOI: 10.1258/jms.2010.010090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To evaluate the attitudes and practices related to prostate-specific antigen (PSA) screening for prostate cancer (PC) among Finnish physicians in 1999 and 2007. Materials and Methods The first questionnaire survey was conducted in 1999 with a mailing to 102 urologists, 679 community physicians and 684 occupational health physicians identified from the membership files of three medical associations. The area of residence was divided into the study area of the Finnish PC screening trial and the rest of Finland. The second survey was carried out in 2007 targeting 168 urologists, 1039 community physicians and 938 occupational health physicians. Results The response proportion was 48% in 1999 and 50% in 2007. In both rounds, urologists regarded PC as a more important public health issue than other physicians. On the other hand, the non-urologists considered early diagnosis and screening more important than the urologists PC was rated by all physicians as a less important public health problem in 2007 than in 1999. A smaller proportion of urologists found routine PSA testing indicated for asymptomatic men, compared with other physicians (40% versus 74-60% in 1999, P < 0.001 and 35% versus 44-37% in 2007, P = 0.005). The proportion of physicians reporting regular PSA screening in asymptomatic men was reduced from 1999 to 2007 (from 18% to 9%, P < 0.0001). Conclusion Based on reported practices of Finnish urologists, community physicians and occupational health physicians, popularity of PSA testing declined between 1999 and 2007. Urologists found PSA testing among asymptomatic men justified less frequently than the other physicians.
Collapse
Affiliation(s)
- Dimitri Pogodin-Hannolainen
- Department of Urology, University of Tampere and Tampere University Hospital, Box 2000, Tampere FI-33521, Finland
| | - Harri Juusela
- Department of Urology, Helsinki University Hospital, Box 340, FI-00029 HUS, Finland
| | - Teuvo L J Tammela
- Department of Urology, University of Tampere and Tampere University Hospital, Box 2000, Tampere FI-33521, Finland
| | - Mirja Ruutu
- Department of Urology, Helsinki University Hospital, Box 340, FI-00029 HUS, Finland
| | - Jussi Aro
- Department of Urology, Helsinki University Hospital, Box 340, FI-00029 HUS, Finland
| | - Liisa Määttänen
- Finnish Cancer Registry, Pieni Roobertinkatu 9, Helsinki FI-00130, Finland
| | - Anssi Auvinen
- Tampere School of Public Health, University of Tampere, FI-33014, Finland
| |
Collapse
|
24
|
Epilogue: Different approaches for prostate cancer screening in the EU? Eur J Cancer 2010; 46:3120-5. [DOI: 10.1016/j.ejca.2010.09.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 09/21/2010] [Accepted: 09/27/2010] [Indexed: 11/19/2022]
|
25
|
Abstract
The most rigorous and valid approach to evaluating cancer screening modalities is the randomized controlled trial (RCT). RCTs are major undertakings and the intricacies of trial design, operations, and management are generally underappreciated by the typical researcher. The purpose of this article is to inform the reader of the "nuts and bolts" of designing and conducting cancer screening RCTs. Following a brief introduction as to why RCTs are critical in evaluating screening modalities, we discuss design considerations, including the choice of design type and duration of follow-up. We next present an approach to sample-size calculations. We then discuss aspects of trial implementation, including recruitment, randomization, and data management. A discussion of commonly employed data analyses comes next, and includes methods for the primary analysis (comparison of cause-specific mortality rates between the screened and control arms for the cancer of interest), as well as for secondary endpoints such as sensitivity. We follow with a discussion of sequential monitoring and interim analysis techniques, which are used to examine the primary outcome while the trial is ongoing. We close with thoughts on lessons learned from past cancer screening RCTs and provide recommendations for future trials. Throughout the presentation we illustrate topics with examples from completed or ongoing RCTs, including the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial and the National Lung Screening Trial (NLST).
Collapse
Affiliation(s)
- Philip C Prorok
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA.
| | | |
Collapse
|
26
|
Schröder FH, Roobol MJ. ERSPC and PLCO prostate cancer screening studies: what are the differences? Eur Urol 2010; 58:46-52. [PMID: 20362385 DOI: 10.1016/j.eururo.2010.03.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 03/18/2010] [Indexed: 11/28/2022]
|
27
|
Abstract
Randomised controlled trials avoid many of the potential biases associated with the evaluation of cancer screening. Nevertheless there are many issues concerning the design of such trials that require careful consideration and that will influence interpretation of the results. This article discusses issues related to recruitment and randomisation, which will affect the extent to which the population studied, is representative of the eventual target population of a screening programme. It addresses sample size considerations, the use of appropriate outcome measures and the timing of the intervention. Finally, issues related to ensuring appropriate analyses are discussed.
Collapse
Affiliation(s)
- Sue Moss
- Cancer Screening Evaluation Unit, Institute of Cancer Research, Sutton, Surrey, UK,
| |
Collapse
|
28
|
Caso JR, Mouraviev V, Tsivian M, Polascik TJ, Moul JW. Prostate Cancer: An Evolving Paradigm. J Endourol 2010; 24:805-9. [DOI: 10.1089/end.2009.0539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jorge R. Caso
- Division of Urologic Surgery and Duke Prostate Center (DPC), Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Vladimir Mouraviev
- Division of Urologic Surgery and Duke Prostate Center (DPC), Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Matvey Tsivian
- Division of Urologic Surgery and Duke Prostate Center (DPC), Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thomas J. Polascik
- Division of Urologic Surgery and Duke Prostate Center (DPC), Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Judd W. Moul
- Division of Urologic Surgery and Duke Prostate Center (DPC), Department of Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
29
|
Kilpeläinen TP, Auvinen A, Määttänen L, Kujala P, Ruutu M, Stenman UH, Tammela TL. Results of the three rounds of the Finnish Prostate Cancer Screening Trial-The incidence of advanced cancer is decreased by screening. Int J Cancer 2010; 127:1699-705. [DOI: 10.1002/ijc.25368] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
30
|
Kerkhof M, Roobol MJ, Cuzick J, Sasieni P, Roemeling S, Schröder FH, Steyerberg EW. Effect of the correction for noncompliance and contamination on the estimated reduction of metastatic prostate cancer within a randomized screening trial (ERSPC section Rotterdam). Int J Cancer 2010; 127:2639-44. [DOI: 10.1002/ijc.25278] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
31
|
Heidenreich A, Aus G, Bolla M, Joniau S, Matveev Vsevolod B, Schmid HP, Zattoni F. [EAU guidelines on prostate cancer]. Actas Urol Esp 2009; 33:113-26. [PMID: 19418833 DOI: 10.1016/s0210-4806(09)74110-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To present a summary of the 2007 version of the European Association of Urology (EAU) guidelines on prostate cancer (PCa). METHODS A literature review of the new data emerging from 2004 to 2007 was performed by the working panel. The guidelines have been updated, and the level of evidence/grade of recommendation was added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews. RESULTS A full version is available at the EAU Office or at www.uroweb.org. Systemic prostate biopsy under ultrasound guidance is the preferred diagnostic method. Active treatment is mostly recommended for patients with localized disease and a long life expectancy, with radical prostatectomy being shown to be superior to watchful waiting in a prospective randomized trial. Nerve-sparing radical prostatectomy represents the approach of choice in organ-confined disease; neoadjuvant androgen deprivation demonstrates no improvement of outcome variables. Radiation therapy should be performed with at least 72 and 78 Gy in low-risk and intermediate- to high-risk PCa, respectively. Monotherapeutic androgen deprivation is the standard of care in metastatic PCa; intermittent androgen deprivation might be an alternative treatment option for selected patients. Follow-up is largely based on prostate-specific antigen and a disease-specific history with imaging only indicated when symptoms occur. Cytotoxic therapy with docetaxel has emerged as the reference treatment for metastatic hormone-refractory PCa. CONCLUSIONS The knowledge in the field of PCa is rapidly changing. These EAU guidelines on PCa summarize the most recent findings and put them into clinical practice.
Collapse
|
32
|
Schröder FH, Hugosson J, Roobol MJ, Tammela TLJ, Ciatto S, Nelen V, Kwiatkowski M, Lujan M, Lilja H, Zappa M, Denis LJ, Recker F, Berenguer A, Määttänen L, Bangma CH, Aus G, Villers A, Rebillard X, van der Kwast T, Blijenberg BG, Moss SM, de Koning HJ, Auvinen A. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009; 360:1320-8. [PMID: 19297566 DOI: 10.1056/nejmoa0810084] [Citation(s) in RCA: 2692] [Impact Index Per Article: 179.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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.)
Collapse
Affiliation(s)
- Fritz H Schröder
- Department of Urology , Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Draisma G, Etzioni R, Tsodikov A, Mariotto A, Wever E, Gulati R, Feuer E, de Koning H. Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context. J Natl Cancer Inst 2009; 101:374-83. [PMID: 19276453 DOI: 10.1093/jnci/djp001] [Citation(s) in RCA: 551] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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 Randomized 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. CONCLUSION The precise definition and the population used to estimate lead time and overdiagnosis can be important drivers of study results and should be clearly specified.
Collapse
Affiliation(s)
- Gerrit Draisma
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
|
35
|
Abstract
Screening should allow for the anticipation of cancer diagnosis at an earlier stage, when curative treatment is possible. Screening for cervical, large bowel, and breast cancer were shown to be effective in reducing mortality. The wide acceptance of the screening concept led to the wide diffusion also of screening of uncertain benefit against prostate cancer and skin melanoma. Diagnostic technologies are continuously evolving, and new tests are proposed to improve existing screenings or as screening tests for additional cancer sites (e.g., lung cancer). Cancer screening, however, is a complex and costly intervention that does not result only in benefits but also may cause harm. A major emerging problem of screening is overdiagnosis, or the detection of cases that would have not progressed to the symptomatic phase in the absence of screening. Thus, both experimental and observational evaluation studies are needed to reduce harm caused by screenings and to select effective interventions among many proposed innovations. Finally, the research of markers to assess the aggressive nature of screen-detected lesions is of great importance to improve screenings ' harm/benefit ratio.
Collapse
Affiliation(s)
- Fabrizio Stracci
- Department of Surgical and Medical Specialties, and Public Health, University of Perugia, Perugia, Italy
| |
Collapse
|
36
|
Lippi G, Montagnana M, Guidi GC, Plebani M. Prostate-specific antigen-based screening for prostate cancer in the third millennium: useful or hype? Ann Med 2009; 41:480-9. [PMID: 19657768 DOI: 10.1080/07853890903156468] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Prostate cancer is the most prevalent malignancy in men and the third leading cause of cancer deaths worldwide. Although the wide-spread introduction of total prostate-specific antigen (tPSA) testing has revolutionized the approach to the managed care of this disease, there are some biological, analytical, clinical, and economical issues that argue against the cost-effectiveness of tPSA-based population screening for early identification of cancer. The on-going standardization/harmonization efforts, along with the outcomes of recent epidemiological investigations, demonstrate that the current tPSA thresholds might be revised and possibly recalculated according to several demographical variables, such as age, ethnicity, genotype, family history, and body mass index. A major shortcoming of tPSA screening is the lack of reliable evidences of reduction in prostate cancer-associated mortality, due to the large lead-time because of the indolent growth rate, the impossibility to differentiate high-grade from indolent cancers, and the treatment-associated morbidity. Since no single tPSA cut-off was proven able to efficiently identify men at higher risk of death, the jeopardy of over-diagnosis and over-treatment is also tangible. The large expenditure is an additional source of concern. Finally, a wide-spread population screening also carries several ethical, social, and psychological implications, which might overwhelm the potential benefits.
Collapse
Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Chemistry, University-Hospital of Verona, Verona, Italy.
| | | | | | | |
Collapse
|
37
|
Sturgeon CM, Duffy MJ, Stenman UH, Lilja H, Brünner N, Chan DW, Babaian R, Bast RC, Dowell B, Esteva FJ, Haglund C, Harbeck N, Hayes DF, Holten-Andersen M, Klee GG, Lamerz R, Looijenga LH, Molina R, Nielsen HJ, Rittenhouse H, Semjonow A, Shih IM, Sibley P, Sölétormos G, Stephan C, Sokoll L, Hoffman BR, Diamandis EP. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Testicular, Prostate, Colorectal, Breast, and Ovarian Cancers. Clin Chem 2008; 54:e11-79. [DOI: 10.1373/clinchem.2008.105601] [Citation(s) in RCA: 458] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background: Updated National Academy of Clinical Biochemistry (NACB) Laboratory Medicine Practice Guidelines for the use of tumor markers in the clinic have been developed.
Methods: Published reports relevant to use of tumor markers for 5 cancer sites—testicular, prostate, colorectal, breast, and ovarian—were critically reviewed.
Results: For testicular cancer, α-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase are recommended for diagnosis/case finding, staging, prognosis determination, recurrence detection, and therapy monitoring. α-Fetoprotein is also recommended for differential diagnosis of nonseminomatous and seminomatous germ cell tumors. Prostate-specific antigen (PSA) is not recommended for prostate cancer screening, but may be used for detecting disease recurrence and monitoring therapy. Free PSA measurement data are useful for distinguishing malignant from benign prostatic disease when total PSA is <10 μg/L. In colorectal cancer, carcinoembryonic antigen is recommended (with some caveats) for prognosis determination, postoperative surveillance, and therapy monitoring in advanced disease. Fecal occult blood testing may be used for screening asymptomatic adults 50 years or older. For breast cancer, estrogen and progesterone receptors are mandatory for predicting response to hormone therapy, human epidermal growth factor receptor-2 measurement is mandatory for predicting response to trastuzumab, and urokinase plasminogen activator/plasminogen activator inhibitor 1 may be used for determining prognosis in lymph node–negative patients. CA15-3/BR27–29 or carcinoembryonic antigen may be used for therapy monitoring in advanced disease. CA125 is recommended (with transvaginal ultrasound) for early detection of ovarian cancer in women at high risk for this disease. CA125 is also recommended for differential diagnosis of suspicious pelvic masses in postmenopausal women, as well as for detection of recurrence, monitoring of therapy, and determination of prognosis in women with ovarian cancer.
Conclusions: Implementation of these recommendations should encourage optimal use of tumor markers.
Collapse
Affiliation(s)
- Catharine M Sturgeon
- Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michael J Duffy
- Department of Pathology and Laboratory Medicine, St Vincent’s University Hospital and UCD School of Medicine and Medical Science, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Ulf-Håkan Stenman
- Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland
| | - Hans Lilja
- Departments of Clinical Laboratories, Urology, and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Nils Brünner
- Section of Biomedicine, Department of Veterinary Pathobiology, Faculty of Life Sciences, University of Copenhagen, Denmark
| | - Daniel W Chan
- Departments of Pathology and Oncology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Richard Babaian
- Department of Urology, The University of Texas Anderson Cancer Center, Houston, TX
| | - Robert C Bast
- Department of Experimental Therapeutics, University of Texas Anderson Cancer Center, Houston, Texas, USA
| | | | - Francisco J Esteva
- Departments of Breast Medical Oncology, Molecular and Cellular Oncology, University of Texas M.D. Anderson Cancer Center, Houston TX
| | - Caj Haglund
- Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Nadia Harbeck
- Frauenklinik der Technischen Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Daniel F Hayes
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Mads Holten-Andersen
- Section of Biomedicine, Department of Veterinary Pathobiology, Faculty of Life Sciences, University of Copenhagen, Denmark
| | - George G Klee
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN
| | - Rolf Lamerz
- Department of Medicine, Klinikum of the University of Munich, Grosshadern, Germany
| | - Leendert H Looijenga
- Laboratory of Experimental Patho-Oncology, Erasmus MC-University Medical Center Rotterdam, and Daniel den Hoed Cancer Center, Rotterdam, the Netherlands
| | - Rafael Molina
- Laboratory of Biochemistry, Hospital Clinico Provincial, Barcelona, Spain
| | - Hans Jørgen Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Copenhagen, Denmark
| | | | - Axel Semjonow
- Prostate Center, Department of Urology, University Clinic Muenster, Muenster, Germany
| | - Ie-Ming Shih
- Departments of Pathology and Oncology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Paul Sibley
- Siemens Medical Solutions Diagnostics, Glyn Rhonwy, Llanberis, Gwynedd, UK
| | | | - Carsten Stephan
- Department of Urology, Charité Hospital, Universitätsmedizin Berlin, Berlin, Germany
| | - Lori Sokoll
- Departments of Pathology and Oncology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Barry R Hoffman
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
| | - Eleftherios P Diamandis
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
| | | |
Collapse
|
38
|
Scales CD, Antonelli J, Curtis LH, Schulman KA, Moul JW. Prostate-specific antigen screening among young men in the United States. Cancer 2008; 113:1315-23. [PMID: 18696715 DOI: 10.1002/cncr.23667] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Disagreement exists on the use of prostate-specific antigen (PSA) tests for cancer-risk stratification in young men in the United States. Little is known about the use of PSA testing in these men. To understand policy implications of risk stratification, the authors sought to characterize PSA use among young men. METHODS The authors used the 2002 Behavioral Risk Factor Surveillance System to study prostate-cancer screening in a representative sample of men aged 40 years and older (n = 58,511). The primary outcome was self-report of a PSA test in the previous year. RESULTS Among men aged 40 to 49 years, 22.5% (95% confidence interval [CI], 21.5-23.5) reported having had a PSA test in the previous year, compared with 53.7% (95% CI, 52.8-54.7; P < .001) of men aged >or=50 years. When sociodemographic characteristics were statistically controlled, young, black, non-Hispanic men were more likely than young, white, non-Hispanic men to report having had a PSA test in the previous year (odds ratio [OR], 2.42; 95% CI, 1.95-3.01; P < .001). In young men, annual household income >or=USD 35,000 (OR, 1.50; 95% CI, 1.26-1.78; P < .001) and an ongoing relationship with a physician (OR, 2.52; 95% CI, 2.06-3.07; P < .001) were associated with PSA testing. CONCLUSIONS One-fifth of young men reported having had a PSA test within the previous year. Young, black, non-Hispanic men are more likely than young, white, non-Hispanic men to report having had a PSA test, although screening in this high-risk group remains suboptimal.
Collapse
Affiliation(s)
- Charles D Scales
- Duke Prostate Center, Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina 27710, USA
| | | | | | | | | |
Collapse
|
39
|
Changes in case mix and treatment patterns in prostate cancer in Saskatchewan during the prostate specific antigen testing era. Cancer Causes Control 2008; 20:201-9. [DOI: 10.1007/s10552-008-9234-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
|
40
|
Ahn J, Berndt SI, Wacholder S, Kraft P, Kibel AS, Yeager M, Albanes D, Giovannucci E, Stampfer MJ, Virtamo J, Thun MJ, Feigelson HS, Cancel-Tassin G, Cussenot O, Thomas G, Hunter DJ, Fraumeni JF, Hoover R, Chanock SJ, Hayes RB. Variation in KLK genes, prostate-specific antigen and risk of prostate cancer. Nat Genet 2008; 40:1032-4; author reply 1035-6. [PMID: 19165914 PMCID: PMC3086200 DOI: 10.1038/ng0908-1032] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jiyoung Ahn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
| | - Sonja I. Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
| | - Sholom Wacholder
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
| | - Peter Kraft
- Program in Molecular and Genetic Epidemiology, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Adam S. Kibel
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Meredith Yeager
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
| | - Edward Giovannucci
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Meir J. Stampfer
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Jarmo Virtamo
- Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Helsinki FIN-0030, Finland
| | - Michael J. Thun
- Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, Georgia 30329, USA
| | - Heather Spencer Feigelson
- Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, Georgia 30329, USA
| | | | - Olivier Cussenot
- CeRePP Hopital Tenon, Assistance Publique-Hôpitaux de Paris, Paris 75020, France
| | - Gilles Thomas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
| | - David J. Hunter
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
- Program in Molecular and Genetic Epidemiology, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Joseph F. Fraumeni
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
| | - Robert Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
| | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
| | - Richard B. Hayes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
| |
Collapse
|
41
|
Schröder FH. Screening for prostate cancer (PC)—an update on recent findings of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Urol Oncol 2008; 26:533-41. [PMID: 18774469 DOI: 10.1016/j.urolonc.2008.03.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
42
|
HIV and prostate cancer: a systematic review of the literature. Prostate Cancer Prostatic Dis 2008; 12:6-12. [DOI: 10.1038/pcan.2008.44] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
43
|
Planelles Gómez J, Beltrán Armada J, Alonso Hernández S, Tarín Planes M, Beamud Cortés M, Gil Salom M. [Value of transrectal FNA in the diagnosis of prostate cancer in elderly patients]. Actas Urol Esp 2008; 32:485-91. [PMID: 18604998 DOI: 10.1016/s0210-4806(08)73872-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To identify if there is a group elderly patients with clinical suspicion of prostate cancer in which pathological confirmation may be unnecessary, and if prostatic transrectal fine needle aspiration (FNA) may be a useful diagnostic tool for old patients. MATERIAL AND METHODS A total of 72 patients aged 75-93 years were evaluated by means of prostatic transrectal FNA. Antibiotic prophylaxis, analgesia or cessation of anticoagulant therapy were not necessary. RESULTS In 35 patients (48.6%) cytological diagnosis was positive for prostatic adenocarcinoma, whereas in 37 cytology was negative for cancer. In 100% of patients with PSA > 30 ng/ml or with PSA > 20 ng/ml and suspicious digital rectal examination FNA results were positive for cancer. 4.1% minor and 1.3% major (acute prostatitis) complications after FNA were observed. CONCLUSIONS In male patients older than 75 years with PSA > 30 ng/ml or with PSA > 20 ng/ml and suspicious digital rectal examination, histological confirmation of carcinoma by prostatic biopsy may be not necessary, because of the high probability of a positive result. When histological confirmation of prostatic carcinoma is required in elderly patients, transrectal prostatic FNA is a valid alternative to transrectal biopsy, due to its excellent tolerance and low complication rate.
Collapse
|
44
|
Improving cancer control in the European Union: Conclusions from the Lisbon round-table under the Portuguese EU Presidency, 2007. Eur J Cancer 2008; 44:1457-62. [DOI: 10.1016/j.ejca.2008.02.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 02/05/2008] [Accepted: 02/06/2008] [Indexed: 01/23/2023]
|
45
|
Abstract
In developed countries, prostate cancer is the second most frequently diagnosed cancer, and the third most common cause of death from cancer in men. Apart from age and ethnic origin, a positive family history is probably the strongest known risk factor. Clinically, prostate cancer is diagnosed as local or advanced, and treatments range from surveillance to radical local treatment or androgen-deprivation treatment. Androgen deprivation reduces symptoms in about 70-80% of patients with advanced prostate cancer, but most tumours relapse within 2 years to an incurable androgen-independent state. The recorded incidence of prostate cancer has substantially increased in the past two decades, probably because of the introduction of screening with prostate-specific antigen, the use of improved biopsy techniques for diagnosis, and increased public awareness. Trends in mortality from the disease are less clearcut. Mortality changes are not of the same magnitude as the changes in incidence, and in some countries mortality has been stable or even decreased. The disparity between reported incidence and mortality rates leads to the probable conclusion that only a small proportion of diagnosed low-risk prostate cancers will progress to life-threatening disease during the lifetime of the patient.
Collapse
Affiliation(s)
- Jan-Erik Damber
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | |
Collapse
|
46
|
Bouchardy C, Fioretta G, Rapiti E, Verkooijen HM, Rapin CH, Schmidlin F, Miralbell R, Zanetti R. Recent trends in prostate cancer mortality show a continuous decrease in several countries. Int J Cancer 2008; 123:421-429. [DOI: 10.1002/ijc.23520] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
47
|
Does educational printed material manage to change compliance with prostate cancer screening? World J Urol 2008; 26:365-73. [DOI: 10.1007/s00345-008-0258-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 03/17/2008] [Indexed: 10/22/2022] Open
|
48
|
Bartsch G, Horninger W, Klocker H, Pelzer A, Bektic J, Oberaigner W, Schennach H, Schäfer G, Frauscher F, Boniol M, Severi G, Robertson C, Boyle P. Tyrol Prostate Cancer Demonstration Project: early detection, treatment, outcome, incidence and mortality. BJU Int 2008; 101:809-16. [PMID: 18321314 DOI: 10.1111/j.1464-410x.2008.07502.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a well-controlled programme of early detection and treatment of prostate cancer in the population of Tyrol, Austria, where such a programme of early detection and treatment was initiated in 1988 and where prostate-specific antigen (PSA) testing was offered for free to all men aged 45-75 years from 1993. SUBJECTS AND METHODS Comparison of prostate cancer mortality rates in Tyrol and the rest of Austria was accomplished through a generalized additive model. A piecewise linear change-point Poisson regression model was used to compare mortality rates in Tyrol and the rest of Austria. Standardized mortality ratios were calculated with reference to the mortality rates in 1986-1990. RESULTS In all, 86.6% of eligible men have been tested at least once since 1993. Cancer deaths in Tyrol in 2005 were 54% (95% confidence interval [CI] 34-69%) lower than expected compared with 29% (95% CI 22-35%) in the rest of Austria. The decreasing trend in prostate cancer mortality was significantly greater in Tyrol compared with the rest of Austria (P = 0.001). A significant migration to lower stage disease occurred and radical prostatectomy was associated with low morbidity. CONCLUSIONS In the Tyrol region where treatment is freely available to all patients, where widespread PSA testing and treatment with curative intent occurs, there was a reduction in prostate cancer mortality rates which was significantly greater than the reduction in the rest of Austria. This reduction in prostate cancer mortality is most probably due to early detection, consequent down-staging and effective treatment of prostate cancer.
Collapse
Affiliation(s)
- Georg Bartsch
- Department of Urology, University of Innsbruck, Innsbruck, Austria.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
[Correct use of prostate-specific antigen in office practice]. Prog Urol 2008; 18:41-5. [PMID: 18342155 DOI: 10.1016/j.purol.2007.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 10/01/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To standardize interpretation and comments of prostate-specific antigen (PSA) assay results by clinical pathology laboratories in office practice. MATERIAL From September 2004 to May 2006, interpretation and comments of PSA assay results performed by 100 different laboratories were analysed retrospectively. RESULTS Nineteen different PSA assay kits were used. The so-called "normal" value for total PSA was less than 4 ng/ml for two-thirds of kits. Determination of the free PSA/total PSA ratio (91 cases) was based on a cut-off value ranging from 10 to 25% and the frequent laboratory comments (89 cases) more often referred to benign prostatic hyperplasia (51 case) than prostate cancer (nine cases). CONCLUSION The marked diversity of PSA assay techniques currently used and the divergent interpretations by various laboratories lead to problems of interpretation for both practitioners and patients.
Collapse
|
50
|
Wong G, Chapman JR, Craig JC. Cancer screening in renal transplant recipients: what is the evidence? Clin J Am Soc Nephrol 2008; 3 Suppl 2:S87-S100. [PMID: 18309007 PMCID: PMC3152279 DOI: 10.2215/cjn.03320807] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Increased cancer risk is well established in the renal transplant population. Little, however, is known about the benefits and harms of cancer screening, treatment effectiveness, and the overall cancer prognosis in renal transplant recipients. In this study, we critically appraised guidelines for cancer screening in the renal transplant and general populations using standard criteria for an evidence-based screening program. Guidelines were included when they were applied to adult participants, had objectives specific to cancer screening, and were written in English. Recommendations for breast and colorectal cancer screening in the general population were supported by evidence of cancer-specific mortality benefits from randomized, controlled trials of cancer screening. Convincing evidence from observational studies had demonstrated population cervical cancer screening was effective, also, test performance of mammography, faecal occult blood testing, and Pap smear were accurate. Population breast, colorectal, and cervical cancer screening also appeared to be good value for money in the general population. On the contrary, recommendations for cancer screening in renal transplant recipients were entirely extrapolated from data in the general population. Studies in the general population have led to the development of cancer screening guidelines in transplant recipients. Because of increased cancer risk, differences in diagnostic test performance, competing risks for deaths from causes such as cardiovascular disease and reduced overall life expectancies, validity of their recommendations are uncertain. Future studies are needed to address these issues to provide the necessary evidence for informed decision-making.
Collapse
Affiliation(s)
- Germaine Wong
- Centre for Kidney Research, Children's Hospital at Westmead, Locked bag 4001, Westmead, NSW 2145, Australia.
| | | | | |
Collapse
|