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Talala K, Walter S, Taari K, Tammela TLJ, Kujala P, Auvinen A. Screening history and risk of death from prostate cancer: a nested case-control study within the screening arm of the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC). Cancer Causes Control 2024; 35:695-703. [PMID: 38063980 PMCID: PMC10960891 DOI: 10.1007/s10552-023-01828-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/02/2023] [Indexed: 03/24/2024]
Abstract
PURPOSE We assessed the risk of death from prostate cancer (PCa) in relation to men's screening histories, i.e., screening attendance among men who were offered screening. METHODS Men in the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC) screening arm were invited to up to three screening rounds with the serum prostate-specific antigen (PSA) test at 4-year intervals during 1996-2007. Case subjects (n = 330) were men who died from PCa. Each case was matched to five controls (n = 1544) among the men who were free of PCa. Screening history was defined as (1) never/ever attended screening prior to the case diagnosis; (2) attended at the first screening round; and (3) recency of screening, calculated as the time from last screening attendance to the date of case diagnosis. The association between screening history and the risk of death from PCa was estimated by odds ratios (OR) with 95% confidence intervals (CI) using conditional logistic regression. RESULTS Having ever attended screening versus never attended was associated with a reduced risk of PCa death (OR 0.60, 95% CI 0.45-0.81) and a similar association was found for those attended (versus not attended) the first screening round (OR 0.67, 95% CI 0.51-0.87). The effect by time since last screen for the risk of PCa death was significantly lower 2-7 years since last screen. CONCLUSION Among men invited to screening, subjects who attended any PSA screening during the previous 19 years had a 40% reduction in PCa mortality compared to non-screened men.
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Affiliation(s)
- Kirsi Talala
- Finnish Cancer Registry, Unioninkatu 22, 00130, Helsinki, Finland.
| | - Stephen Walter
- Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 3L8, Canada
| | - Kimmo Taari
- Department of Urology, Helsinki University Hospital and University of Helsinki, 00029, Helsinki, Finland
| | - Teuvo L J Tammela
- Faculty of Medicine and Health Technology, Tampere University, 33014, Tampere, Finland
- Department of Surgery, Tampere University Hospital, 33521, Tampere, Finland
| | - Paula Kujala
- Department of Pathology, Fimlab Laboratories, 33101, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences/Health Sciences, Tampere University, 33014, Tampere, Finland
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Neupane S, Nevalainen J, Raitanen J, Talala K, Kujala P, Taari K, Tammela TLJ, Steyerberg EW, Auvinen A. Prognostic Index for Predicting Prostate Cancer Survival in a Randomized Screening Trial: Development and Validation. Cancers (Basel) 2021; 13:435. [PMID: 33498854 PMCID: PMC7865328 DOI: 10.3390/cancers13030435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 11/17/2022] Open
Abstract
We developed and validated a prognostic index to predict survival from prostate cancer (PCa) based on the Finnish randomized screening trial (FinRSPC). Men diagnosed with localized PCa (N = 7042) were included. European Association of Urology risk groups were defined. The follow-up was divided into three periods (0-3, 3-9 and 9-20 years) for development and two corresponding validation periods (3-6 and 9-15 years). A multivariable complementary log-log regression model was used to calculate the full prognostic index. Predicted cause-specific survival at 10 years from diagnosis was calculated for the control arm using a simplified risk score at diagnosis. The full prognostic index discriminates well men with PCa with different survival. The area under the curve (AUC) was 0.83 for both the 3-6 year and 9-15 year validation periods. In the simplified risk score, patients with a low risk score at diagnosis had the most favorable survival, while the outcome was poorest for the patients with high risk scores. The prognostic index was able to distinguish well between men with higher and lower survival, and the simplified risk score can be used as a basis for decision making.
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Affiliation(s)
- Subas Neupane
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland; (J.N.); (J.R.); (A.A.)
| | - Jaakko Nevalainen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland; (J.N.); (J.R.); (A.A.)
| | - Jani Raitanen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland; (J.N.); (J.R.); (A.A.)
- UKK Institute for Health Promotion Research, FI-33014 Tampere, Finland
| | - Kirsi Talala
- Finnish Cancer Registry, FI-00130 Helsinki, Finland;
| | - Paula Kujala
- Department of Pathology, FIMLAB laboratory services, FI-33014 Tampere, Finland;
| | - Kimmo Taari
- Department of Urology, Helsinki University Hospital, University of Helsinki, FI-00014 Helsinki, Finland;
| | - Teuvo L. J. Tammela
- Department of Urology, Tampere University Hospital, University of Tampere, FI-33521 Tampere, Finland;
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands
| | - Anssi Auvinen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland; (J.N.); (J.R.); (A.A.)
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Remmers S, Roobol MJ. Personalized strategies in population screening for prostate cancer. Int J Cancer 2020; 147:2977-2987. [PMID: 32394421 PMCID: PMC7586980 DOI: 10.1002/ijc.33045] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022]
Abstract
This review discusses evidence for population-based screening with contemporary screening tools. In Europe, prostate-specific antigen (PSA)-based screening led to a relative reduction of prostate cancer (PCa) mortality, but also to a substantial amount of overdiagnosis and unnecessarily biopsies. Risk stratification based on a single variable (a clinical variable or based on the presence of a lesion on prostate imaging) or based on multivariable approaches can aid in reducing unnecessary prostate biopsies and overdiagnosis by selecting men who can benefit from further clinical assessment. Multivariable approaches include clinical variables, and biomarkers, often combined in risk calculators or nomograms. These risk calculators can also incorporate the result of MRI imaging. In general, as compared to a purely PSA based approach, the combination of relevant prebiopsy information results in superior selection of men at higher risk of harboring clinically significant prostate cancer. Currently, it is not possible to draw any conclusions on the superiority of these multivariable risk-based approaches since head-to-head comparisons are virtually lacking. Recently initiated large population-based screening studies in Finland, Germany and Sweden, incorporating various multivariable risk stratification approaches will hopefully give more insight in whether the harm-benefit ratio can be improved, that is, maintain (or improving) the ability to reduce metastatic disease and prostate cancer mortality while reducing harm caused by unnecessary testing and overdiagnosis including related overtreatment.
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Affiliation(s)
- Sebastiaan Remmers
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Lindberg A, Talala K, Kujala P, Stenman UH, Taari K, Kilpeläinen TP, Tammela TL, Auvinen A. Bias-corrected estimates of effects of PSA screening decisions on the risk of prostate cancer diagnosis and death: Analysis of the Finnish randomized study of screening for prostate cancer. Int J Cancer 2019; 145:632-638. [PMID: 30653262 DOI: 10.1002/ijc.32129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/31/2018] [Accepted: 11/22/2018] [Indexed: 12/28/2022]
Abstract
More information is needed about effects of prostate-specific antigen (PSA) screening for informed decision making. The objective of our study is to evaluate the effects of an implemented screening decision on the risk of prostate cancer (PC) diagnosis and PC death. In a randomized trial, 31,867 Finnish men aged 55-67 years were allocated to the screening arm and 48,282 to the control arm during 1996-1999. Two to three screening rounds were offered to the screening arm with a PSA cut-off of 4.0 ng/ml. A counterfactual exclusion method was used to adjust for the effects of screening noncompliance and PSA contamination on risk of PC death and PC incidence by prognostic group at 15 years of follow up. After correcting for noncompliance and contamination, PSA screening led to 32.4 (95% CI 26.4, 38.6) more PC diagnoses per 1,000 men after 15 years and 1.4 (95% CI 0.0, 2.8) fewer PC deaths compared to the control arm. The corresponding results of an intention-to-screen analysis were 16.5 (95% CI 12.3, 20.7) and 0.8 (95% CI 0.5, 2.0), respectively. These results can be used for patient counseling in informed decision making about PC screening. A limitation of the study was the lack of comprehensive data on contamination.
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Affiliation(s)
- Antti Lindberg
- Faculty of Medicine and Biosciences, University of Tampere, Tampere, Finland
| | | | - Paula Kujala
- Department of Pathology, Fimlab Laboratory Services, Tampere, Finland
| | - Ulf-Håkan Stenman
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Departments of Clinical Chemistry and Urology, Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Taari
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Departments of Clinical Chemistry and Urology, Helsinki University Hospital, Helsinki, Finland
| | - Tuomas P Kilpeläinen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Departments of Clinical Chemistry and Urology, Helsinki University Hospital, Helsinki, Finland
| | - Teuvo L Tammela
- Faculty of Medicine and Biosciences, University of Tampere, Tampere, Finland
- Department of Urology, Tampere University Hospitala, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences/Health Sciences, University of Tampere, Tampere, Finland
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Could Differences in Treatment Between Trial Arms Explain the Reduction in Prostate Cancer Mortality in the European Randomized Study of Screening for Prostate Cancer? Eur Urol 2019; 75:1015-1022. [PMID: 30928162 DOI: 10.1016/j.eururo.2019.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/08/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Differential treatment between trial arms has been suggested to bias prostate cancer (PC) mortality in the European Randomized Study of Screening for Prostate Cancer (ERSPC). OBJECTIVE To quantify the contribution of treatment differences to the observed PC mortality reduction between the screening arm (SA) and the control arm (CA). DESIGN, SETTING, AND PARTICIPANTS A total of 14 136 men with PC (SA: 7310; CA: 6826) in the core age group (55-69yr) at 16yr of follow-up. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The outcomes measurements were observed and estimated numbers of PC deaths by treatment allocation in the SA and CA, respectively. Primary treatment allocation was modeled using multinomial logistic regression adjusting for center, age, year, prostate-specific antigen, grade group, and tumor-node-metastasis stage. For each treatment, logistic regression models were fitted for risk of PC death, separately for the SA and CA, and using the same covariates as for the treatment allocation model. Treatment probabilities were multiplied by estimated PC death risks for each treatment based on one arm, and then summed and compared with the observed number of deaths. RESULTS AND LIMITATIONS The difference between the observed and estimated treatment distributions (hormonal therapy, radical prostatectomy, radiotherapy, and active surveillance/watchful waiting) in the two arms ranged from -3.3% to 3.3%. These figures, which represent the part of the treatment differences between arms that cannot be explained by clinicopathological differences, are small compared with the observed differences between arms that ranged between 7.2% and 10.1%. The difference between the observed and estimated numbers of PC deaths among men with PC was 0.05% (95% confidence interval [CI] -0.1%, 0.2%) when applying the CA model to the SA, had the two groups received identical primary treatment, given their clinical characteristics. When instead applying the SA model to the CA, the difference was, as expected, very similar-0.01% (95% CI -0.3%, 0.2%). Consistency of the results of the models demonstrates the robustness of the modeling approach. As the observed difference between trial arms was 4.2%, our findings suggest that differential treatment explains only a trivial proportion of the main findings of ERSPC. A limitation of the study is that only data on primary treatment were available. CONCLUSIONS Use of prostate-specific antigen remains the predominant explanation for the reduction in PC mortality seen in the ERSPC trial and is not attributable to differential treatment between trial arms. PATIENT SUMMARY This study shows that prostate cancer deaths in the European screening trial (European Randomized Study of Screening for Prostate Cancer) were prevented because men were diagnosed and treated earlier through prostate-specific antigen screening, and not because of different, or better, treatment in the screening arm compared with the control arm.
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Neupane S, Steyerberg E, Raitanen J, Talala K, Pylväläinen J, Taari K, Tammela TL, Auvinen A. Prognostic factors of prostate cancer mortality in a Finnish randomized screening trial. Int J Urol 2017; 25:270-276. [PMID: 29224236 DOI: 10.1111/iju.13508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/07/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To identify the prognostic factors of prostate cancer death among patients enrolled in a Finnish prostate cancer screening trial. METHODS Data on TNM stage, Gleason score, serum prostate-specific antigen at diagnosis, comorbidity and primary treatment were collected from medical records, as well as date and cause of death from Statistics Finland. Four prognostic risk groups were defined based on TNM stage, Gleason score and prostate-specific antigen at diagnosis. Hazard ratios and their 95% confidence intervals for prostate cancer death were calculated using Cox regression and competing-risk analysis with follow up from randomization. The differences in the effects of prognostic factors were assessed using interaction terms. RESULTS The 15-year survival was significantly lower among cases in the control arm compared with the screening arm (0.90 vs 0.92). However, the survival advantage was limited to screen-detected cases (0.94 vs 0.91 in cases detected outside screening). The prognostic risk group was the strongest factor predicting survival in the control arm, but weaker in screen-detected cases. Advanced disease was associated with substantially poorer outcome in cases detected outside screening than in screen-detected disease. Primary treatment had a similar effect in all groups. Comorbidity had a small prognostic effect in the control arm only. CONCLUSIONS Prognostic factors had a different effect on the outcome of cases detected through screening as those diagnosed otherwise. A high diagnostic prostate-specific antigen and advanced disease carried a poor prognosis, especially among the cases detected outside screening, even when lead-time was eliminated. This shows that the screening resulted in earlier treatment among the cases in the screening arm.
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Affiliation(s)
- Subas Neupane
- Faculty of Social Science, Health Sciences, University of Tampere, Tampere, Finland
| | - Ewout Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jani Raitanen
- Faculty of Social Science, Health Sciences, University of Tampere, Tampere, Finland.,UKK Institute for Health Promotion Research, Tampere, Finland
| | | | - Juho Pylväläinen
- Faculty of Social Science, Health Sciences, University of Tampere, Tampere, Finland
| | - Kimmo Taari
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teuvo Lj Tammela
- Department of Urology, Tampere University Hospital, Tampere, Finland.,School of Medicine, University of Tampere, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Science, Health Sciences, University of Tampere, Tampere, Finland
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7
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Assel M, Sjöblom L, Murtola TJ, Talala K, Kujala P, Stenman UH, Taari K, Auvinen A, Vickers A, Visakorpi T, Tammela TL, Lilja H. A Four-kallikrein Panel and β-Microseminoprotein in Predicting High-grade Prostate Cancer on Biopsy: An Independent Replication from the Finnish Section of the European Randomized Study of Screening for Prostate Cancer. Eur Urol Focus 2017; 5:561-567. [PMID: 29137895 DOI: 10.1016/j.euf.2017.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/05/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND A panel of four kallikrein markers (total, free, and intact prostate-specific antigen [PSA] and human kallikrein-related peptidase 2 [hK2]) improves predictive accuracy for Gleason score ≥7 (high-grade) prostate cancer among men biopsied for elevated PSA. A four-kallikrein panel model was originally developed and validated by the Dutch center of the European Randomized Study of Screening for Prostate Cancer (ERSPC). The kallikrein panel is now commercially available as 4Kscore™. OBJECTIVE To assess whether these findings could be replicated among participants in the Finnish section of ERSPC (FinRSPC) and whether β-microseminoprotein (MSP), a candidate prostate cancer biomarker, adds predictive value. DESIGN, SETTING, AND PARTICIPANTS Among 4861 biopsied screening-positive participants in the first three screening rounds of FinRSPC, a case-control subset was selected that included 1632 biopsy-positive cases matched by age at biopsy to biopsy-negative controls. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The predictive accuracy of prespecified prediction models was compared with biopsy outcomes. RESULTS AND LIMITATIONS Among men with PSA of 4.0-25ng/ml, 1111 had prostate cancer, 318 of whom had high-grade disease. Total PSA and age predicted high-grade cancer with an area under the curve of 0.648 (95% confidence interval [CI] 0.614-0.681) and the four-kallikrein panel increased discrimination to 0.746 (95% CI 0.717-0.774). Adding MSP to the four-kallikrein panel led to a significant (Wald test; p=0.015) but small increase (0.003) in discrimination. Limitations include a risk of verification bias among men with PSA of 3.0-3.99ng/ml and the absence of digital rectal examination results. CONCLUSIONS These findings provide additional evidence that kallikrein markers can be used to inform biopsy decision-making. Further studies are needed to define the role of MSP. PATIENT SUMMARY Four kallikrein markers and β-microseminoprotein in blood improve discrimination of high-grade prostate cancer at biopsy in men with elevated prostate-specific antigen.
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Affiliation(s)
- Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Liisa Sjöblom
- Prostate Cancer Research Center, Institute of Biosciences and Medical Technology, University of Tampere, Tampere, Finland; Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - Teemu J Murtola
- Prostate Cancer Research Center, School of Health Sciences, University of Tampere, Tampere, Finland; Department of Urology, Tampere University Hospital, Tampere, Finland
| | | | - Paula Kujala
- Fimlab Laboratories, Tampere University Hospital, Tampere, Finland; Department of Pathology, Tampere University Hospital, Tampere, Finland
| | - Ulf-Håkan Stenman
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Taari
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anssi Auvinen
- Prostate Cancer Research Center, School of Health Sciences, University of Tampere, Tampere, Finland
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tapio Visakorpi
- Prostate Cancer Research Center, Institute of Biosciences and Medical Technology, University of Tampere, Tampere, Finland; Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - Teuvo L Tammela
- Prostate Cancer Research Center, School of Health Sciences, University of Tampere, Tampere, Finland; Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Hans Lilja
- Prostate Cancer Research Center, Institute of Biosciences and Medical Technology, University of Tampere, Tampere, Finland; Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Translational Medicine, Lund University, Malmö, Sweden.
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Estimate of Opportunistic Prostate Specific Antigen Testing in the Finnish Randomized Study of Screening for Prostate Cancer. J Urol 2017; 198:50-57. [PMID: 28104375 DOI: 10.1016/j.juro.2017.01.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Screening for prostate cancer remains controversial, although ERSPC (European Randomized Study of Screening for Prostate Cancer) showed a 21% relative reduction in prostate cancer mortality. The Finnish Randomized Study of Screening for Prostate Cancer, which is the largest component of ERSPC, demonstrated a statistically nonsignificant 16% mortality benefit in a separate analysis. The purpose of this study was to estimate the degree of contamination in the control arm of the Finnish trial. MATERIALS AND METHODS Altogether 48,295 and 31,872 men were randomized to the control and screening arms, respectively. The screening period was 1996 to 2007. The extent of prostate specific antigen testing was analyzed retrospectively using laboratory databases. The incidence of T1c prostate cancer (impalpable prostate cancer detected by elevated prostate specific antigen) was determined from the national Finnish Cancer Registry. RESULTS Approximately 1.4% of men had undergone prostate specific antigen testing 1 to 3 years before randomization. By the first 4, 8 and 12 years of followup 18.1%, 47.7% and 62.7% of men in the control arm had undergone prostate specific antigen testing at least once and in the screening arm the proportions were 69.8%, 81.1% and 85.2%, respectively. The cumulative incidence of T1c prostate cancer was 6.1% in the screening arm and 4.5% in the control arm (RR 1.21, 95% CI 1.13-1.30). CONCLUSIONS A large proportion of men in the control arm had undergone a prostate specific antigen test during the 15-year followup. Contamination is likely to dilute differences in prostate cancer mortality between the arms in the Finnish screening trial.
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Estimating bias in causes of death ascertainment in the Finnish Randomized Study of Screening for Prostate Cancer. Cancer Epidemiol 2016; 45:1-5. [DOI: 10.1016/j.canep.2016.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/23/2016] [Accepted: 08/30/2016] [Indexed: 01/12/2023]
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10
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Walsh EI, Turner EL, Lane JA, Donovan JL, Neal DE, Hamdy FC, Martin RM. Characteristics of men responding to an invitation to undergo testing for prostate cancer as part of a randomised trial. Trials 2016; 17:497. [PMID: 27737692 PMCID: PMC5064919 DOI: 10.1186/s13063-016-1624-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sociodemographic characteristics are associated with participating in cancer screening and trials. We compared the characteristics of those responding with those not responding to a single invitation for prostate-specific antigen (PSA) testing for prostate cancer as part of the Cluster randomised triAl of PSA testing for Prostate cancer (CAP). METHODS Age, rurality and deprivation among 197,763 men from 271 cluster-randomised primary care centres in the UK were compared between those responding (n = 90,300) and those not responding (n = 100,953) to a prostate cancer testing invitation. RESULTS There was little difference in age between responders and nonresponders. Responders were slightly more likely to come from urban rather than rural areas and were slightly less deprived than those who did not respond. CONCLUSION These data indicate similarities in age and only minor differences in deprivation and urban location between responders and nonresponders. These differences were smaller, but in the same direction as those observed in other screening trials. TRIAL REGISTRATION ISRCTN92187251 . Registered on 29 November 2004.
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Affiliation(s)
- Eleanor I. Walsh
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Emma L. Turner
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - J. Athene Lane
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jenny L. Donovan
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - David E. Neal
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Freddie C. Hamdy
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Richard M. Martin
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - and the CAP & ProtecT Trial Groups
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, OX3 9DU UK
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Abstract
PURPOSE OF REVIEW The aim of this review was to highlight important articles in the field of prostate cancer screening published during 2015 and early 2016. Four major areas were identified for the purpose: screening strategies, post-United States Preventive Services Task Force (USPSTF) 2011-2012, screening trends/patterns, and shared decision making. RECENT FINDINGS Several studies furthered the evidence that screening reduces the risk of metastasis and death from prostate cancer. Multiplex screening strategies are of proven benefit; genetics and MRI need further evaluation. Prostate-specific antigen (PSA) screening rates declined in men above age of 50 years, as did the overall prostate cancer incidence following the USPSTF 2011-2012 recommendation against PSA. The consequences of declining screening rates will become apparent in the next few years. More research is needed to identify the most optimal approach to engage in, and implement, an effective shared decision-making in clinical practice. SUMMARY Data emerging in 2015 provided evidence on the question of how best to screen and brought more steps in the right direction of 'next-generation prostate cancer screening'. Screening is an ongoing process in all men regardless of whether or not they might benefit from early detection and treatment. After the USPSTF 2011-2012 recommendation, the rates of PSA testing are declining; however, this decline is observed in all men and not solely in those who will not benefit from the screening. The long-term effect of this recommendation might not be as anticipated. More studies are needed on how to implement the best available evidence on who, and when, to screen in clinical practice.
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Affiliation(s)
- Sigrid V. Carlsson
- Memorial Sloan Kettering Cancer Center, Department of
Surgery and Epidemiology & Biostatistics, New York, USA
- Institute of Clinical Sciences, Sahlgrenska Academy at
Gothenburg University, Sweden
| | - Monique J. Roobol
- Department of Urology, Erasmus University Medical Center,
Rotterdam, The Netherlands
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