Interval Cancers in Prostate Cancer Screening
Background: The incidence of prostate cancer has increased substantially since it became common practice to screen asymptomatic men for the disease. The European Randomized Study of Screening for Prostate Cancer (ERSPC) was initiated in 1993 to determine how prostate-specific antigen (PSA) screening affects prostate cancer mortality. Variations in the screening algorithm, such as the interval between screening rounds, likely influence the morbidity, mortality, and quality of life of the screened population.
Methods: We compared the number and characteristics of interval cancers, defined as those diagnosed during the screening interval but not detected by screening, in men in the screening arm of the ERSPC who were aged 55-65 years at the time of the first screening and were participating through two centers of the ERSPC: Gothenburg (2-year screening interval, n = 4202) and Rotterdam (4-year screening interval, n = 13301). All participants who were diagnosed with prostate cancer through December 31, 2005, but at most 10 years after the initial screening were ascertained by linkage with the national cancer registries. A potentially life-threatening (aggressive) interval cancer was defined as one with at least one of the following characteristics at diagnosis: stage M1 or N1, plasma PSA concentration greater than 20.0 ng/mL, or Gleason score greater than 7. We used Mantel Cox regression to assess differences between rates of interval cancers and aggressive interval cancers at the two centers. All statistical tests were two-sided.
Results: The 10-year cumulative incidence of all prostate cancers in Rotterdam versus Gothenburg was 1118 (8.41%) versus 552 (13.14%) (P<.001), the cumulative incidence of interval cancer was 57 (0.43%) versus 31 (0.74%) (P = .51), and the cumulative incidence of aggressive interval cancer was 15 (0.11%) versus 5 (0.12%) (P = .72).
Conclusion: The rate of interval cancer, especially aggressive interval cancer, was low in this study. The 2-year screening interval had higher detection rates than the 4-year interval but did not lead to lower rates of interval and aggressive interval prostate cancers.
Since the introduction of serum prostate-specific antigen (PSA) testing in the late 1980s, prostate cancer incidence has risen substantially, mainly due to mass screening of clinically asymptomatic men. In 1984, 5.1% of all newly diagnosed prostate carcinomas were detected by PSA testing. By 1990 this percentage had already increased to 60.6% of prostate cancers that were diagnosed in the United States. Screening for prostate cancer remains a controversial issue. There is still a lack of scientific data that prove the effectiveness of PSA screening with respect to the prevention of deaths from prostate cancer and whether it will outweigh the loss of quality of life due to overdetection and overtreatment and will justify the expenditure of a considerable part of the total budget of health care resources.
The European Randomized Study of Screening for Prostate Cancer (ERSPC) was initiated with the intent to show or exclude an effect of screening on prostate cancer mortality. In addition, the ERSPC will allow a risk-to-benefit analysis, including parameters of quality of life and costs. Variations in the screening protocol, particularly in the interval between different screening rounds, are likely to influence the outcome of screening, whereas the length of the screening interval affects the detection rate, efficacy, and costs.
The rate of interval cancers (those clinically diagnosed within a screening interval) gives an indication of the sensitivity of the screening program and the appropriateness of the length of the screening interval. Different screening intervals are used within the ERSPC. In this study, we compared the number and characteristics of interval cancers in the Swedish center (Gothenburg, 2-year screening interval) and the Dutch center (Rotterdam, 4-year screening interval) of ERSPC. These two centers of ERSPC were chosen because the duration and completeness of available follow-up data are comparable.
Abstract and Introduction
Abstract
Background: The incidence of prostate cancer has increased substantially since it became common practice to screen asymptomatic men for the disease. The European Randomized Study of Screening for Prostate Cancer (ERSPC) was initiated in 1993 to determine how prostate-specific antigen (PSA) screening affects prostate cancer mortality. Variations in the screening algorithm, such as the interval between screening rounds, likely influence the morbidity, mortality, and quality of life of the screened population.
Methods: We compared the number and characteristics of interval cancers, defined as those diagnosed during the screening interval but not detected by screening, in men in the screening arm of the ERSPC who were aged 55-65 years at the time of the first screening and were participating through two centers of the ERSPC: Gothenburg (2-year screening interval, n = 4202) and Rotterdam (4-year screening interval, n = 13301). All participants who were diagnosed with prostate cancer through December 31, 2005, but at most 10 years after the initial screening were ascertained by linkage with the national cancer registries. A potentially life-threatening (aggressive) interval cancer was defined as one with at least one of the following characteristics at diagnosis: stage M1 or N1, plasma PSA concentration greater than 20.0 ng/mL, or Gleason score greater than 7. We used Mantel Cox regression to assess differences between rates of interval cancers and aggressive interval cancers at the two centers. All statistical tests were two-sided.
Results: The 10-year cumulative incidence of all prostate cancers in Rotterdam versus Gothenburg was 1118 (8.41%) versus 552 (13.14%) (P<.001), the cumulative incidence of interval cancer was 57 (0.43%) versus 31 (0.74%) (P = .51), and the cumulative incidence of aggressive interval cancer was 15 (0.11%) versus 5 (0.12%) (P = .72).
Conclusion: The rate of interval cancer, especially aggressive interval cancer, was low in this study. The 2-year screening interval had higher detection rates than the 4-year interval but did not lead to lower rates of interval and aggressive interval prostate cancers.
Introduction
Since the introduction of serum prostate-specific antigen (PSA) testing in the late 1980s, prostate cancer incidence has risen substantially, mainly due to mass screening of clinically asymptomatic men. In 1984, 5.1% of all newly diagnosed prostate carcinomas were detected by PSA testing. By 1990 this percentage had already increased to 60.6% of prostate cancers that were diagnosed in the United States. Screening for prostate cancer remains a controversial issue. There is still a lack of scientific data that prove the effectiveness of PSA screening with respect to the prevention of deaths from prostate cancer and whether it will outweigh the loss of quality of life due to overdetection and overtreatment and will justify the expenditure of a considerable part of the total budget of health care resources.
The European Randomized Study of Screening for Prostate Cancer (ERSPC) was initiated with the intent to show or exclude an effect of screening on prostate cancer mortality. In addition, the ERSPC will allow a risk-to-benefit analysis, including parameters of quality of life and costs. Variations in the screening protocol, particularly in the interval between different screening rounds, are likely to influence the outcome of screening, whereas the length of the screening interval affects the detection rate, efficacy, and costs.
The rate of interval cancers (those clinically diagnosed within a screening interval) gives an indication of the sensitivity of the screening program and the appropriateness of the length of the screening interval. Different screening intervals are used within the ERSPC. In this study, we compared the number and characteristics of interval cancers in the Swedish center (Gothenburg, 2-year screening interval) and the Dutch center (Rotterdam, 4-year screening interval) of ERSPC. These two centers of ERSPC were chosen because the duration and completeness of available follow-up data are comparable.
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