2028 “ESCAPES”-MEN WHO DEVELOP METASTASIS AND/OR DIE FROM PROSTATE CANCER DESPITE SCREENING-: LONG-TERM RESULTS FROM THE ERSPC, SECTION ROTTERDAM

Abstract

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 20112028 “ESCAPES”-MEN WHO DEVELOP METASTASIS AND/OR DIE FROM PROSTATE CANCER DESPITE SCREENING-: LONG-TERM RESULTS FROM THE ERSPC, SECTION ROTTERDAM Xiaoye Zhu, Pim J. van Leeuwen, Meelan Bul, Monique J. Roobol, and Fritz H. Schröder Xiaoye ZhuXiaoye Zhu Rotterdam, Netherlands More articles by this author , Pim J. van LeeuwenPim J. van Leeuwen Rotterdam, Netherlands More articles by this author , Meelan BulMeelan Bul Rotterdam, Netherlands More articles by this author , Monique J. RoobolMonique J. Roobol Rotterdam, Netherlands More articles by this author , and Fritz H. SchröderFritz H. Schröder Rotterdam, Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2257AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We aimed to identify and characterize as “escapes”, men who developed metastasis and/or died from PCa despite screening, within the European Randomized Study of Screening for Prostate Cancer (ERSPC), section Rotterdam. With this knowledge, the ultimate goal is to define an improved screening strategy. METHODS From 1993–1999, a total of 42376 men aged 55–74 yrs identified from population registries in the Rotterdam region were randomized into a screening (21210) or control arm (21166). In the screening arm, 19950 men were actually screened. Men with PSA ≥3.0 ng/ml were recommended to undergo prostate biopsy. The screening interval was 4 yrs. At 4 and 8 years after the initial screening round, these men were invited to undergo repeat screening, unless they passed the age of 75 years. The follow-up was complete until January 1, 2009. RESULTS From the 19950 screened men, 2317 were diagnosed with PCa of whom 168 developed metastasis and/or died from PCa (table 1). The median follow-up was 11.1 years for the whole cohort and 7.3 years for men diagnosed with PCa. More than half of these “escapes” were found in the initial screening round (94 out of 168). 59 “escapes” were diagnosed during a screening interval, of whom 25 were no longer screened because they passed the age cutoff. Table 1. Characteristics escapeŝ No. (%) of cases Screen-detected (n=109) Interval-detected (n=59) Total (n=168) Age at diagnosis years, median 68 74 69 PSA level at diagnosis ng/ml, median 13.6 56.6 20.3 Clinical stage T2 52(47.7) 28(47.5) 80(47.6) T3 51(46.8) 16(27.1) 67(39.9) T4 6(5.5) 13(22.0) 19(11.3) Unknown 0 2(3.4) 2(1.2) Gleason score 6 27(24.8) 7(11.9) 34(20.2) 7 48(44.0) 8(13.6) 56(33.3) 8 34(31.2) 25(42.4) 59(35.1) Unknown 0 19(32.2) 19(11.3) High-risk at diagnosis⁎ 79(72.5) 50(84.7) 129(76.8) ̂ defined as men who developed metastasis and/or died from PCa; ⁎ defined as 2002 American Joint Commission on Cancer clinical stage T3, or PSA > 20 ng/ml, or Gleason score 8. CONCLUSIONS In total we have identified 168 “escapes” among 2317 cancers (7.3%) within our screening cohort of 19950 men (0.8%). Possible mechanisms behind escaping despite screening are non-attending, inadequate screening tests, screening interval, age cut-off and undertreatment. International co-operation is crucial to compare the “escapes” of our cohort with other study groups which have different, more aggressive screening strategies, in order to achieve improvements of the current screening algorithm. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e811 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xiaoye Zhu Rotterdam, Netherlands More articles by this author Pim J. van Leeuwen Rotterdam, Netherlands More articles by this author Meelan Bul Rotterdam, Netherlands More articles by this author Monique J. Roobol Rotterdam, Netherlands More articles by this author Fritz H. Schröder Rotterdam, Netherlands More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...