EAU 2018: Screening and Prostate Cancer Mortality: Results of a Unique Cohort at 19 Years of Follow-Up

Copenhagen, Denmark (UroToday.com) Dr. Osses and colleagues presented results of screening and prostate cancer mortality with 19-years of follow-up. The European Randomized study of Screening for Prostate Cancer (ERSPC) has shown that PSA-based screening results in a significant prostate cancer mortality reduction [1], however the relatively short follow-up and PSA contamination may affect study results [2]. The objective of this study was to present data of an ERSPC Rotterdam pilot study with men randomized in the period 1991-1992, an era where PSA testing was uncommon in the Netherlands (thus, theoretically less contamination).

For this study, 1,135 men age 55-74 years were randomized to a control (n=581) or screening arm (554). Men with PSA level >10.0 ng/ml were excluded from randomization and referred to their general practitioner. PSA testing was offered to all men randomized in the screening arm with a 4-year interval and applying an upper age limit of 74 years of age. A PSA level ≥3.0 ng/ml triggered a prostate biopsy. The primary endpoint was PCa-specific mortality. 

The median age of men participating in the study was 64 years (IQR 60-69) and follow-up time was 19 years (IQR 12-24). In the screening arm, 72 prostate cancers were detected, including 23 (32%) with Gleason score ≥3+4 prostate cancer. In the control arm 57 prostate cancers were detected, including 28 (49%) with Gleason score ≥3+4 prostate cancer. Excess incidence was 32 prostate cancer cases per 1000 men randomized. Metastatic disease was detected in three screened men versus eight men in the control arm. During follow-up, 7 and 14 men progressed to metastatic disease in screening and control arm, respectively, resulting in an overall relative risk (RR) of metastatic disease of 0.53 (95%CI 0.21-1.29) in favor of screening. Currently 63% (718/1135) of all men randomized have died. The RR of prostate cancer death in men allocated to the screening arm relative to the control arm was 0.48 (95%CI 0.17-1.36). These results confirm earlier reports for the ERSPC trial regarding lead time of advanced disease (± 3 years), metastatic disease developing despite screening, and reduction of metastatic disease preceding prostate cancer mortality reduction.

The authors concluded that data from this cohort, systematically screened largely in a period without contamination and with more than 60% of men that died, confirm that PSA-based screening reduces prostate cancer-specific mortality and metastatic disease. Furthermore, they suggest that reductions are considerable and if confirmed in larger datasets should again be weighed against harms of unnecessary testing and over-diagnosis. This paper won best presentation for the session.


Presented by: Daniel Osses, Erasmus University Medical Center, Rotterdam, The Netherlands
Co-Authors: Remmers S, Schröder F, Van Der Kwast T, Roobol M

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, twitter: @zklaassen_md at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark