435: When is Decreased Prostate Cancer Mortality to be Expected Provided that Efficacious Prostate Cancer Screening is Introduced?

10017 Background: It remains unknown whether more intense prostate cancer screening and treatment reduces prostate cancer mortality. We describe the experiences of two population-based cohorts with 15-years follow-up (1987–2001) to address the following questions: 1) does more intense screening and treatment for prostate cancer lead to lower mortality in community settings, and 2) do older men (age ≥75–79) benefit from more intense prostate cancer screening and treatment. Methods: Population-based cohort study consisting of white male Medicare beneficiaries who resided in the regions covered by the Seattle (N=88,863) and Connecticut (N=114,785) cancer registries. Inclusion criteria are age 65–79 and free of prostate cancer on January 1, 1987. All study subjects were followed through death or the end of 2001. The main outcomes are rates of screening for prostate cancer, treatment with radical prostatectomy, external beam radiotherapy, and prostate cancer specific mortality. Results: Between 1987 and 1990, compared to men in Connecticut, men in the Seattle region were 5.4 times (95% C.I. 4.8 - 6.1) more likely to undergo PSA testing, 2.2 times (95% C.I. 1.8 - 2.7) more likely to under go prostate biopsy, 5.9 times (95% C.I. 5.5 - 6.9) more likely to have radial prostatectomy, and 2.3 times (95% C.I. 2.2 - 2.5) more likely to have external beam radiation. The cumulative risk of radical prostatectomy or external beam radiation reached 9.1% in the Seattle cohort and 5.0% in the Connecticut cohort in 2001. After 15 years of follow-up, prostate cancer mortality rates were similar for subjects in the two study regions (hazard ratio of Seattle to CT: 1.01, 95% C.I. 0.93 - 1.09). For older men (aged 75–79 in 1987), however, the prostate cancer mortality rate was slightly higher in the Seattle than the Connecticut cohort (hazard ratio: 1.16, 95% C.I. 1.02 - 1.32). Conclusion: More intense screening for prostate cancer, surgery or radiation among a cohort of Medicare beneficiaries in the Seattle area compared with their counterparts in Connecticut has not lead to significantly lower mortality from prostate cancer over 15 years of follow-up. No significant financial relationships to disclose.

Download Full-text

MP46-01 DEVELOPMENT OF PROSTATE CANCER SCREENING NOMOGRAMS FOR PREDICTING 15-YEAR RISK OF PROSTATE CANCER DIAGNOSIS AND PROSTATE CANCER MORTALITY, WITH OTHER-CAUSE MORTALITY AS COMPETING EVENT

The Journal of Urology ◽

10.1016/j.juro.2018.02.1460 ◽

2018 ◽

Vol 199 (4S) ◽

Author(s):

Sigrid Carlsson ◽

Michael Brooks ◽

Alexander Zajichek ◽

Kevin Chagin ◽

Jonas Hugosson ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Cancer Diagnosis ◽

Cancer Mortality ◽

Prostate Cancer Screening ◽

Prostate Cancer Diagnosis ◽

Prostate Cancer Mortality

Download Full-text

Values and preferences of men for undergoing prostate-specific antigen screening for prostate cancer: a systematic review

BMJ Open ◽

10.1136/bmjopen-2018-025470 ◽

2018 ◽

Vol 8 (9) ◽

pp. e025470 ◽

Cited By ~ 5

Author(s):

Robin W M Vernooij ◽

Lyubov Lytvyn ◽

Hector Pardo-Hernandez ◽

Loai Albarqouni ◽

Carlos Canelo-Aybar ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Prostate Specific Antigen ◽

Cancer Mortality ◽

Prostate Cancer Screening ◽

Grey Literature ◽

Specific Antigen ◽

Risk Of Bias ◽

Prostate Cancer Mortality ◽

Psa Screening

ObjectivesTo investigate men’s values and preferences regarding prostate-specific antigen (PSA)-based screening for prostate cancer.DesignSystematic review.Data sourcesWe searched MEDLINE, EMBASE, PsycINFO and grey literature up to 2 September 2017.Eligibility criteriaPrimary studies of men’s values and preferences regarding the benefits and harms of PSA screening.Data extraction and synthesisTwo independent reviewers extracted data and assessed risk of bias with a modified version of a risk of bias tool for values and preferences studies, the International Patient Decision Aid Standards instrument V.3 and the Cochrane Collaboration risk of bias tool.ResultsWe identified 4172 unique citations, of which 11 studies proved eligible. Five studies investigated PSA screening using a direct choice study design, whereas six used decisions aids displaying patient-important outcomes. The direct choice studies used different methodologies and varied considerably in the reporting of outcomes. Two studies suggested that men were willing to forego screening with a small benefit in prostate cancer mortality if it would decrease the likelihood of unnecessary treatment or biopsies. In contrast, one study reported that men were willing to accept a substantial overdiagnosis to reduce their risk of prostate cancer mortality. Among the six studies involving decision aids, willingness to undergo screening varied substantially from 37% when displaying a hypothetical reduction in mortality of 10 per 1000 men, to 44% when displaying a reduction in mortality of 7 per 1000. We found no studies that specifically investigated whether values and preferences differed among men with family history, of African descent or with lower socioeconomic levels.ConclusionThe variability of men’s values and preferences reflect that the decision to screen is highly preference sensitive. Our review highlights the need for shared decision making in men considering prostate cancer screening.Trial registration numberCRD42018095585.

Download Full-text

Abstract LB-15: Frequency of aspirin use and prostate cancer mortality among prostate cancer cases in the control arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.

10.1158/1538-7445.am2013-lb-15 ◽

2013 ◽

Cited By ~ 1

Author(s):

Sarah E. Daugherty ◽

Ruth Pfeiffer ◽

Armen Ghazarian ◽

Grant Izmirlian ◽

Phil Prorok ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Cancer Mortality ◽

Prostate Cancer Mortality ◽

Cancer Screening Trial ◽

Screening Trial

Download Full-text

How Does Early Detection by Screening Affect Disease Progression?

Medical Decision Making ◽

10.1177/0272989x10396717 ◽

2011 ◽

Vol 31 (4) ◽

pp. 550-558 ◽

Cited By ~ 15

Author(s):

Elisabeth M. Wever ◽

Gerrit Draisma ◽

Eveline A. M. Heijnsdijk ◽

Harry J. de Koning

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Early Detection ◽

Cancer Mortality ◽

Mortality Data ◽

Mortality Reduction ◽

Screening Effect ◽

Cure Model ◽

Prostate Cancer Mortality ◽

Shift Model

Background. Simulation models are essential tools for estimating benefits of cancer screening programs. Such models include a screening-effect model that represents how early detection by screening followed by treatment affects disease-specific survival. Two commonly used screening-effect models are the stage-shift model, where mortality benefits are explained by the shift to more favorable stages, and the cure model, where early detection enhances the chances of cure from disease. Objective. This article describes commonly used screening-effect models and analyses their predicted mortality benefit in a model for prostate cancer screening. Method. The MISCAN simulation model was used to predict the reduction of prostate cancer mortality in the European Randomized Study of Screening for Prostate Cancer (ERSPC) Rotterdam. The screening-effect models were included in the model. For each model the predictions of prostate cancer mortality reduction were calculated. The study compared 4 screening-effect models, which are versions of the stage-shift model or the cure model. Results. The stage-shift models predicted, after a follow-up of 9 years, reductions in prostate cancer mortality varying from 38% to 63% for ERSPC-Rotterdam compared with a 27% reduction observed in the ERSPC. The cure models predicted reductions in prostate cancer mortality varying from 21% to 27%. Conclusions. The differences in predicted mortality reductions show the importance of validating models to observed trial mortality data. The stage-shift models considerably overestimated the mortality reduction. Therefore, the stage-shift models should be used with care, especially when modeling the effect of screening for cancers with long lead times, such as prostate cancer.

Download Full-text

Design-corrected variation by centre in mortality reduction in the ERSPC randomised prostate cancer screening trial

Journal of Medical Screening ◽

10.1177/0969141316652174 ◽

2016 ◽

Vol 24 (2) ◽

pp. 98-103 ◽

Cited By ~ 2

Author(s):

Matti Hakama ◽

Sue M Moss ◽

Ulf-Hakan Stenman ◽

Monique J Roobol ◽

Marco Zappa ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Ratio ◽

Cancer Mortality ◽

Prostate Cancer Screening ◽

Target Population ◽

Mortality Reduction ◽

Randomised Study ◽

Prostate Cancer Mortality ◽

Specific Variation

Objectives To calculate design-corrected estimates of the effect of screening on prostate cancer mortality by centre in the European Randomised Study of Screening for Prostate Cancer (ERSPC). Setting The ERSPC has shown a 21% reduction in prostate cancer mortality in men invited to screening with follow-up truncated at 13 years. Centres either used pre-consent randomisation (effectiveness design) or post-consent randomisation (efficacy design). Methods In six centres (three effectiveness design, three efficacy design) with follow-up until the end of 2010, or maximum 13 years, the effect of screening was estimated as both effectiveness (mortality reduction in the target population) and efficacy (reduction in those actually screened). Results The overall crude prostate cancer mortality risk ratio in the intervention arm vs control arm for the six centres was 0.79 ranging from a 14% increase to a 38% reduction. The risk ratio was 0.85 in centres with effectiveness design and 0.73 in those with efficacy design. After correcting for design, overall efficacy was 27%, 24% in pre-consent and 29% in post-consent centres, ranging between a 12% increase and a 52% reduction. Conclusion The estimated overall effect of screening in attenders (efficacy) was a 27% reduction in prostate cancer mortality at 13 years’ follow-up. The variation in efficacy between centres was greater than the range in risk ratio without correction for design. The centre-specific variation in the mortality reduction could not be accounted for by the randomisation method.

Download Full-text