Prostate cancer screening in the Randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: Mortality results after 13 years of follow-up - Abstract

Division of Urologic Surgery, Washington University School of Medicine, St Louis, MO (GLA, RLG); Anschutz Cancer Pavilion, University of Colorado, Denver, CO (EDC); Huntsman Cancer Institute at the University of Utah Health Sciences Center, Salt Lake City, UT (SSB); University of California Los Angeles Immunogenetics Center, Los Angeles, CA (DC); University of Minnesota School of Public Health, Minneapolis, MN (TRC); University of Alabama at Birmingham, School of Medicine, Birmingham, AL (EP, MNF); Lombardi Cancer Center, Georgetown University, Washington, DC (CI); Henry Ford Health System, Detroit, MI (PAK); Marshfield Clinic Research Foundation, Marshfield, WI (DJR); University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA (JLW); Pacific Health Research Institute, Honolulu, HI (LAY); Westat, Inc, Rockville, MD (BO'B, LRR); Information Management Services, Rockville, MD (JDC, JMR, TLR); Division of Cancer Epidemiology and Genetics (AWH), National Cancer Institute, National Institutes of Health, Bethesda, MD (AWH); Biometry Research Group (GI, PCP) and Early Detection Research Group (PFP), Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD and Office of the Director (BSK); Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (ABM); Office of Disease Prevention, National Institutes of Health, Bethesda, MD (JKG).



The prostate component of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial was undertaken to determine whether there is a reduction in prostate cancer mortality from screening using serum prostate-specific antigen (PSA) testing and digital rectal examination (DRE). Mortality after 7-10 years of follow-up has been reported previously. We report extended follow-up to 13 years after the trial.MethodsA total of 76 685 men, aged 55-74 years, were enrolled at 10 screening centers between November 1993 and July 2001 and randomly assigned to the intervention (organized screening of annual PSA testing for 6 years and annual DRE for 4 years; 38 340 men) and control (usual care, which sometimes included opportunistic screening; 38 345 men) arms. Screening was completed in October 2006. All incident prostate cancers and deaths from prostate cancer through 13 years of follow-up or through December 31, 2009, were ascertained. Relative risks (RRs) were estimated as the ratio of observed rates in the intervention and control arms, and 95% confidence intervals (CIs) were calculated assuming a Poisson distribution for the number of events. Poisson regression modeling was used to examine the interactions with respect to prostate cancer mortality between trial arm and age, comorbidity status, and pretrial PSA testing. All statistical tests were two-sided.ResultsApproximately 92% of the study participants were followed to 10 years and 57% to 13 years. At 13 years, 4250 participants had been diagnosed with prostate cancer in the intervention arm compared with 3815 in the control arm. Cumulative incidence rates for prostate cancer in the intervention and control arms were 108.4 and 97.1 per 10 000 person-years, respectively, resulting in a relative increase of 12% in the intervention arm (RR = 1.12, 95% CI = 1.07 to 1.17). After 13 years of follow-up, the cumulative mortality rates from prostate cancer in the intervention and control arms were 3.7 and 3.4 deaths per 10 000 person-years, respectively, resulting in a non-statistically significant difference between the two arms (RR = 1.09, 95% CI = 0.87 to 1.36). No statistically significant interactions with respect to prostate cancer mortality were observed between trial arm and age (P(interaction) = .81), pretrial PSA testing (P(interaction) = .52), and comorbidity (P(interaction) = .68).ConclusionsAfter 13 years of follow-up, there was no evidence of a mortality benefit for organized annual screening in the PLCO trial compared with opportunistic screening, which forms part of usual care, and there was no apparent interaction with age, baseline comorbidity, or pretrial PSA testing.


Written by:
Andriole GL, Crawford ED, Grubb RL 3rd, Buys SS, Chia D, Church TR, Fouad MN, Isaacs C, Kvale PA, Reding DJ, Weissfeld JL, Yokochi LA, O'Brien B, Ragard LR, Clapp JD, Rathmell JM, Riley TL, Hsing AW, Izmirlian G, Pinsky PF, Kramer BS, Miller AB, Gohagan JK, Prorok PC; for the PLCO Project Team.   Are you the author?

Reference: J Natl Cancer Inst. 2012 Jan 6. [Epub ahead of print]

PubMed Abstract
PMID: 22228146 Prostate Cancer Section



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