Metastatic Prostate Cancer Incidence and Prostate-specific Antigen Testing: New Insights from the European Randomized Study of Screening for Prostate Cancer.
- Buzzoni C Clinical and Descriptive Epidemiology and Registries Unit, ISPO - Cancer Research and Prevention Institute, Florence, Italy.
- Auvinen A School of Health Sciences, University of Tampere, Tampere, Finland.
- Roobol MJ Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Carlsson S Department of Urology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
- Moss SM Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
- Puliti D Clinical and Descriptive Epidemiology and Registries Unit, ISPO - Cancer Research and Prevention Institute, Florence, Italy.
- de Koning HJ Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
- Bangma CH Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Denis LJ Oncological Centre Antwerp, Belgium.
- Kwiatkowski M Department of Urology, Kantonsspital Aarau, Aarau, Switzerland; Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.
- Lujan M Urology Department, Hospital Infanta Cristina, Parla, Madrid, Spain.
- Nelen V Provinciaal Instituut voor Hygiene, Antwerp, Belgium.
- Paez A Department of Urology, Hospital Universitario de Fuenlabrada, Madrid, Spain.
- Randazzo M Department of Urology, Kantonsspital Aarau, Aarau, Switzerland; Department of Urology University Hospital Zürich, Zürich, Switzerland.
- Rebillard X Department of Urology, Clinique BeauSoleil - EA2415, Montpellier, France.
- Tammela TL Department of Urology, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland.
- Villers A Department of Urology, CHU Lille, Univ Lille Nord de France, Lille, France.
- Hugosson J Department of Urology, Sahlgrenska Academy at University of Gothenburg, Sweden.
- Schröder FH Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Zappa M Clinical and Descriptive Epidemiology and Registries Unit, ISPO - Cancer Research and Prevention Institute, Florence, Italy. Electronic address: m.zappa@ispo.toscana.it.
- 2015-03-21
Published in:
- European urology. - 2015
Metastatic cancer incidence
Mortality reduction
PSA
Prostate screening
Aged
Early Detection of Cancer
Humans
Incidence
Kallikreins
Male
Middle Aged
Neoplasm Grading
Neoplasm Metastasis
Neoplasm Staging
Prostate-Specific Antigen
Prostatic Neoplasms
Regression Analysis
Risk Assessment
English
BACKGROUND
The European Randomized Study of Screening for Prostate Cancer (ERSPC) has shown a 21% reduction in prostate cancer (PCa) mortality and a 1.6-fold increase in PCa incidence with prostate-specific antigen (PSA)-based screening (at 13 yr of follow-up). We evaluated PCa incidence by risk category at diagnosis across the study arms to assess the potential impact on PCa mortality.
DESIGN, SETTING, AND PARTICIPANTS
Information on arm, centre, T and M stage, Gleason score, serum PSA at diagnosis, age at randomisation, follow-up time, and vital status were extracted from the ERSPC database. Four risk categories at diagnosis were defined: 1, low; 2, intermediate; 3, high; 4, metastatic disease. PSA (≤100 or >100 ng/ml) was used as the indicator of metastasis.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Incidence rate ratios (IRRs) for screening versus control arm by risk category at diagnosis and follow-up time were calculated using Poisson regression analysis for seven centres. Follow-up was truncated at 13 yr. Missing data were imputed using chained equations. The analyses were carried out on an intention-to-treat basis.
RESULTS AND LIMITATIONS
In the screening arm, 7408 PCa cases were diagnosed and 6107 in the control arm. The proportion of missing stage, Gleason score, or PSA value was comparable in the two arms (8% vs 10%), but differed among centres. The IRRs were elevated in the screening arm for the low-risk (IRR: 2.14; 95% CI, 2.03-2.25) and intermediate-risk (IRR: 1.24; 95% CI, 1.16-1.34) categories at diagnosis, equal to unity for the high-risk category at diagnosis (IRR: 1.00; 95% CI, 0.89-1.13), and reduced for metastatic disease at diagnosis (IRR: 0.60; 95% CI, 0.52-0.70). The IRR of metastatic disease had temporal pattern similar to mortality, shifted forwards an average of almost 3 yr, although the mortality reduction was smaller.
CONCLUSIONS
The results confirm a reduction in metastatic disease at diagnosis in the screening arm, preceding mortality reduction by almost 3 yr.
PATIENT SUMMARY
The findings of this study indicate that the decrease in metastatic disease at diagnosis is the major determinant of the prostate cancer mortality reduction in the European Randomized study of Screening for Prostate Cancer.
The European Randomized Study of Screening for Prostate Cancer (ERSPC) has shown a 21% reduction in prostate cancer (PCa) mortality and a 1.6-fold increase in PCa incidence with prostate-specific antigen (PSA)-based screening (at 13 yr of follow-up). We evaluated PCa incidence by risk category at diagnosis across the study arms to assess the potential impact on PCa mortality.
DESIGN, SETTING, AND PARTICIPANTS
Information on arm, centre, T and M stage, Gleason score, serum PSA at diagnosis, age at randomisation, follow-up time, and vital status were extracted from the ERSPC database. Four risk categories at diagnosis were defined: 1, low; 2, intermediate; 3, high; 4, metastatic disease. PSA (≤100 or >100 ng/ml) was used as the indicator of metastasis.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Incidence rate ratios (IRRs) for screening versus control arm by risk category at diagnosis and follow-up time were calculated using Poisson regression analysis for seven centres. Follow-up was truncated at 13 yr. Missing data were imputed using chained equations. The analyses were carried out on an intention-to-treat basis.
RESULTS AND LIMITATIONS
In the screening arm, 7408 PCa cases were diagnosed and 6107 in the control arm. The proportion of missing stage, Gleason score, or PSA value was comparable in the two arms (8% vs 10%), but differed among centres. The IRRs were elevated in the screening arm for the low-risk (IRR: 2.14; 95% CI, 2.03-2.25) and intermediate-risk (IRR: 1.24; 95% CI, 1.16-1.34) categories at diagnosis, equal to unity for the high-risk category at diagnosis (IRR: 1.00; 95% CI, 0.89-1.13), and reduced for metastatic disease at diagnosis (IRR: 0.60; 95% CI, 0.52-0.70). The IRR of metastatic disease had temporal pattern similar to mortality, shifted forwards an average of almost 3 yr, although the mortality reduction was smaller.
CONCLUSIONS
The results confirm a reduction in metastatic disease at diagnosis in the screening arm, preceding mortality reduction by almost 3 yr.
PATIENT SUMMARY
The findings of this study indicate that the decrease in metastatic disease at diagnosis is the major determinant of the prostate cancer mortality reduction in the European Randomized study of Screening for Prostate Cancer.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.eururo.2015.02.042
- PMID 25791513
- Persistent URL
- https://folia.unifr.ch/global/documents/9535
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