Abstract
Background
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.
Methods
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.
Results
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).
Conclusions
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.
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Reference
American Cancer Society (2007) Cancer Facts and Figures
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 97:237–244
Andriole GL, Levin DL, Crawford ED, Gelmann EP, Pinsky PF et al (2005) Prostate cancer screening in the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial: findings from the initial screening round of a randomized trial. J Natl Cancer Inst 97: 433–438
Friedman GD, Hiatt RA, Quesenberry CP, Selby JV (1991) Case–control study of screening for prostate cancer by digital rectal examination. Lancet 337:1526–1529
Jacobsen SJ, Bergstralh EJ, Katusic SK, Guess HA, Darby CH, Silverstein MD, Oesterling JE, Lieber MM (1998) Screening digital rectal examination and prostate cancer mortality: a population-based case–control study. Urology 52:173–179
Richert-Boe KE, Humphrey LL, Glass AG, Weiss NS (1998) Screening digital rectal examination and prostate cancer mortality: a case–control study. J Med Screen 5:99–103
Perron L, Moore L, Bairati I, Bernard PM, Meyer F (2002) PSA screening and prostate cancer mortality. CMAJ 166:586–591
Weinmann S, Richert-Boe KE, Glass AG, Weiss NS (2004) Prostate cancer screening and mortality: a case–control study (United States). Cancer Causes Control 14:133–138
Weinmann S, Richert-Boe KE, Van Den Eeden SK, Enger SM, Rybicki BA, Shapiro JA, Weiss NS (2005) Screening by prostate-specific antigen and digital rectal examination in relation to prostate cancer mortality: a case–control study. Epidemiology 16:367–376
Kopec JA, Goel V, Bunting PS, Neuman J, Sayre EC, Warde P, Levers P, Fleshner N (2005) Screening with prostate specific antigen and metastatic prostate cancer risk: a population based case–control study. J Urol 174:495–449
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 58:417–424
Horninger W, Berger A, Pelzer A, Klocker H, Oberaigner W, Schonitzer D, Severi G, Robertson C, Boyle P, Bartsch G (2005) Screening for prostate cancer: updated experience from the Tyrol study. Can J Urol 12(Suppl 1):7–13
Oberaigner W, Horninger W, Klocker H, Schonitzer D, Stuhlinger W, Bartsch G (2006) Reduction of prostate cancer mortality in Tyrol, Austria, after introduction of prostate-specific antigen testing. Am J Epidemiol 164:376–384
Concato J, Wells CK, Horwitz RI, Penson D, Fincke G, Berlowitz DR, Froehlich G, Blake D, Vickers MA, Gehr GA, Raheb NH, Sullivan G, Peduzzi P (2006) The effectiveness of screening for prostate cancer: a nested case–control study. Arch Intern Med 166:38–43
Labrie F, Candas B, Dupont A, Cusan L, Gomez JL, Suburu RE, Diamond P, Levesque J, Belanger A (1999) Screening decreases prostate cancer death: first analysis of the 1988 Quebec prospective randomized controlled trial. Prostate 38:83–91
Labrie F, Candas B, Cusan L, Gomez JL, Belanger A, Brousseau G, Chevrette E, Levesque J (2004) Screening decreases prostate cancer mortality: 11-year follow-up of the 1988 Quebec prospective randomized controlled trial. Prostate 59:311–388
Sandblom G, Varenhorst E, Lofman O, Rosell J, Carlsson P (2004) Clinical consequences of screening for prostate cancer: 15 years follow-up of a randomised controlled trial in Sweden. Eur Urol 46:717–723; discussion 724
Schroder FH, Roobol MJ, Damhuis RA, de Koning HJ, Blijenberg BG, Van der Kwast TH, Kirkels WJ, Bangma CH (2005) Rotterdam randomized pilot studies of screening for prostate cancer—an overview after 10 years. J Natl Cancer Inst 97:696
Ciatto S, Gervasi G, Gorini G, Lombardi C, Zappa M, Crocetti E (2006) Prostate cancer specific mortality in the florence screening pilot study cohort 1992–1993. Eur J Cancer 42:1858–1862
Stanford JL, Wicklund KG, McKnight B, Daling JR, Brawer MK (1999) Vasectomy and risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 8:881–886
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
Smith RA, Cokkinides V, Eyre HJ (2005) American cancer society guidelines for the early detection of cancer, 2005. CA Cancer J Clin 55:31–44
Weiss NS (1994) Application of the case–control method in the evaluation of screening. Am J Epidemiology 16:102–108
Weiss NS, Etzioni R (2002) Estimating the influence of rescreening interval on the benefits associated with cancer screening: approaches and limitation. Epidemiology 13:713–717
Weiss NS, Lazovich DA (1996) Case–control studies of screening efficacy: the use of persons newly diagnosed with cancer who later sustain an unfavorable outcome. Am J Epidemiol 143:319–322
Acknowledgments
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.
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Agalliu, I., Weiss, N.S., Lin, D.W. et al. Prostate cancer mortality in relation to screening by prostate-specific antigen testing and digital rectal examination: a population-based study in middle-aged men. Cancer Causes Control 18, 931–937 (2007). https://doi.org/10.1007/s10552-007-9031-7
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DOI: https://doi.org/10.1007/s10552-007-9031-7