Prostate-Specific Antigen Screening and Mortality from Prostate Cancer
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
There is no available evidence from randomized trials that early detection of prostate cancer improves health outcomes, but the prostate-specific antigen (PSA) test is commonly used to screen men for prostate cancer.
The objective of the study is to see if screening with PSA decreases mortality from prostate cancer.
Design, setting, and participants
This is a case-control study using one-to-one matching on race, age, and time of availability of exposure to PSA screening. Decedents, 380, from New Jersey Vital Statistics 1997 to 2000 inclusive, 55–79 years of age at diagnosis were matched to living controls without metastatic prostate cancer. Medical records were obtained from all providers, and we abstracted information about PSA tests from 1989 to the time of diagnosis in each index case.
Measurements consist of a comparison of screening (yes, no) between cases and controls. Measure of association was the odds ratio.
Eligible cases were diagnosed each year from 1989 to 1999 with the median year being 1993. PSA screening was evident in 23.2–29.2% of cases and 21.8–26.1% of controls depending on the screening criteria. The unadjusted, matched odds ratio for dying of prostate cancer if ever screened was 1.09 (95% CI 0.76 to 1.60) for the most restrictive criteria and 1.19 (95% CI, 0.85 to 1.66) for the least restrictive. Adjustment for comorbidity and education level made no significant differences in these values. There were no significant interactions by age or race.
PSA screening using an ever/never tabulation for tests from 1989 until 2000 did not protect New Jersey men from prostate cancer mortality.
- Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2001.
- US Task Force on Prevention. Screening for prostate cancer: recommendation and rationale. Ann of Intern Med. 2002;137:915–16.
- Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer, 2006. CA Cancer J Clin. 2006;56:11–25. CrossRef
- Sox HC, Mulrow C. An editorial update: should benefits of radical prostatectomy affect the decision to screen for early prostate cancer? Ann Intern Med. 2005;143:232–3.
- Gann PH, Hennekens CH, Stampfer MJ. A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer. JAMA. 1995;273:289–94. CrossRef
- Jacobsen SJ, Bergstralh EJ, Guess HA, et al. Predictive properties of serum prostate-specific antigen testing in a community-based setting. Arch Intern Med. 1996;156:2462–8. CrossRef
- van der Cruijsen-Koeter IW, Vis AN, Roobol MJ, et al. Comparison of screen detected and clinically diagnosed prostate cancer in the European randomized study of screening for prostate cancer, section Rotterdam. J Urol. 2005;174:121–5. CrossRef
- Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < = 4.0 ng per milliliter. N Engl J Med. 2004;350:2239–46. CrossRef
- Bill-Axelson A, Holmberg L, Ruutu M, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med. 2005;352:1977–84. CrossRef
- Holmberg L, Bill-Axelson A, Helgesen F, et al. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med. 2002;347:781–9. CrossRef
- Concato J, Wells CK, Horwitz RI, et al. The effectiveness of screening for prostate cancer: a nested case-control study. Arch Intern Med. 2006;166:38–43. CrossRef
- Kopec JA, Goel V, Bunting PS, et al. Screening with prostate-specific antigen and metastatic prostate cancer risk: a population based case-control study. J Urol. 2005;174:495–9. CrossRef
- Weinmann S, Richert-Boe K, Glass AG, Weiss NS. Prostate cancer screening and mortality: a case-control study. Cancer Causes Control. 2004;15:133–8. CrossRef
- New Jersey Administrative Code (N.J.A.C. 8:57A-1.1 et seq.).
- Waksberg J. Sampling methods for random digit dialing. J Am Statistical Association. 1978;73:40–6. CrossRef
- Schlesselman JJ. Analysis of Case-Control Studies: Design, Conduct, Analysis. New York: Oxford University Press; 1982.
- Selby JV, Friedman GD, Quesenberry CP Jr., Weiss NS. Effect of fecal occult blood testing on mortality from colorectal cancer: a case-control study. Ann Intern Med. 1993;118:1–6.
- Selby JV, Friedman GD, Quesenberry CP Jr., Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326:653–7. CrossRef
- Muller AD, Sonnenberg A. Protection by endoscopy against death from colorectal cancer. A case-control study among veterans. Arch Intern Med. 1995;155:1741–8. CrossRef
- Clarke EA, Anderson TW. Does screening by “Pap” smears help prevent cervical cancer? A case-control study. Lancet. 1979;2:1–4. CrossRef
- van der Graaf Y, Zielhuis GA, Peer PG, Vooijs PG. The effectiveness of cervical screening: a population-based case-control study. J Clin Epidemiol. 1988;41121–6. CrossRef
- Demissie K, Mills OF, Rhoads GG. Empirical comparison of the results of randomized controlled trials and case-control studies in evaluating the effectiveness of screening mammography. J Clin Epidemiol. 1998;51:81–91. CrossRef
- Albertsen PC, Hanley JA, Fine J. 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA. 2005;293:2095–2101. CrossRef
- Gohagan JK, Prorok PC, Hayes RB, Kramer BS. The Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial of the National Cancer Institute: history, organization, and status. Control Clin Trials. 2000;21:251S. CrossRef
- de Koning HJ, Auvinen A, Berenguer Sanchez A, et al. Large-scale randomized prostate cancer screening trials: program performances in the European Randomized Screening for Prostate Cancer trial and the Prostate, Lung, Colorectal and Ovary cancer trial. Int J Cancer. 2002;97:237–44. CrossRef
- Frankel S, Smith GD, Donovan J, Neal D. Screening for prostate cancer. Lancet. 2003;361:1122–8. CrossRef
- Ransohoff DF, McNaughton Collins M, Fowler FJ. Why is prostate cancer screening so common when the evidence is so uncertain? A system without negative feedback. Am J Med. 2002;113:663–7. CrossRef
- Prostate-Specific Antigen Screening and Mortality from Prostate Cancer
Journal of General Internal Medicine
Volume 23, Issue 3 , pp 248-253
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- prostate cancer
- prostate specific antigen
- Industry Sectors
- Author Affiliations
- 1. Department of Epidemiology, UMDNJ-School of Public Health, Piscataway, NJ, USA
- 2. Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- 4. Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- 3. New Jersey Department of Health and Senior Services, Trenton, NJ, USA