Prostate cancer mortality in relation to screening by prostate-specific antigen testing and digital rectal examination: a population-based study in middle-aged men
Although prostate cancer screening by measurement of serum prostate-specific antigen (PSA) and digital rectal examination (DRE) is common in clinical practice, the impact of such screening on prostate cancer-specific mortality remains uncertain.
Data from a population-based case–control study in King County, Washington, among men aged 50–64 years (706 cases, 645 controls) were used to examine the relationships between PSA and DRE screening and fatal prostate cancer and other-cause mortality. Incident cases were diagnosed in 1993–1996, identified via the Seattle-Puget Sound SEER cancer registry and followed for vital status through 1 June 2007. Controls were ascertained by random digit dialing and frequency age-matched to cases. The screening variable used in this analysis was self-reported receipt of one or more PSA and/or DRE tests performed as part of a routine checkup in the five-year period before diagnosis or reference date.
A smaller proportion of men with fatal prostate cancer had one or more PSA and/or DRE screening tests compared to controls, resulting in an adjusted odds ratios (OR) of 0.38 (95% CI 0.19–0.77). There was no association, however, between PSA and/or DRE screening and other-cause mortality (OR = 1.02; 95% CI 0.51–2.02).
Results of this study suggest a reduction in prostate cancer-specific mortality associated with PSA and/or DRE screening in middle-aged men. Findings should be interpreted cautiously, however, as results are based on observational data. Further, the study was not able to separate the relative efficacy of PSA versus DRE screening.
KeywordsProstate cancer screening Prostate-specific antigen (PSA) test Digital rectal examination Prostate cancer-specific mortality
We thank all men who participated in this study for their time, effort and co-operation. We thank Dr. Ruth Etzioni for helpful suggestions and comments on the manuscript. Supported by NIH grants RO1-CA56678 and P50-CA97186, NIH Contract N01-CN-05230 from the National Cancer Institute, and additional support was provided by the Fred Hutchinson Cancer Research Center.
- 1.American Cancer Society (2007) Cancer Facts and FiguresGoogle Scholar
- 2.De Koning HJ, Auvinen A, Berenguer Sanchez A, Calais da Silva F, Ciatto S et al (2002) 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 97:237–244PubMedCrossRefGoogle Scholar
- 11.Bartsch G, Horninger W, Klocker H, Reissigl A, Oberaigner W, Schonitzer D, Severi G, Robertson C, Boyle P (2001) Tyrol Prostate Cancer Screening Group. Prostate cancer mortality after introduction of prostate-specific antigen mass screening in the Federal State of Tyrol, Austria. Urology 58:417–424Google Scholar
- 21.Breslow NE, Day NE (1980) Statistical methods in cancer research, Volume 1. The analysis of case–control studies. International Agency for Research on Cancer, Lyon Google Scholar
- 23.Weiss NS (1994) Application of the case–control method in the evaluation of screening. Am J Epidemiology 16:102–108Google Scholar