854 SCREENING HISTORY OF MEN WITH FATAL PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced III1 Apr 2010854 SCREENING HISTORY OF MEN WITH FATAL PROSTATE CANCER Joshua J. Meeks, Stacy Loeb, Ronald Kim, Donghui Kan, Jessica A. Banks, Phillip R. Cooper, Brian T. Helfand, and William J. Catalona Joshua J. MeeksJoshua J. Meeks Chicago, IL More articles by this author , Stacy LoebStacy Loeb Baltimore, MD More articles by this author , Ronald KimRonald Kim Chicago, IL More articles by this author , Donghui KanDonghui Kan Chicago, IL More articles by this author , Jessica A. BanksJessica A. Banks Chicago, IL More articles by this author , Phillip R. CooperPhillip R. Cooper Chicago, IL More articles by this author , Brian T. HelfandBrian T. Helfand Chicago, IL More articles by this author , and William J. CatalonaWilliam J. Catalona Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1610AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The European Randomized Study of Screening for Prostate Cancer (ERSPC) demonstrated that PSA screening was associated with a significant mortality benefit; whereas, the Prostate, Lung, Colorectal and Ovarian (PLCO) screening trial did not find a difference in mortality. Possible reasons for this discrepancy include high rates of contamination and pre-screening as well as considerable delays in the follow-up of abnormal screening test results in the PLCO trial. The objective of our study was to compare the screening history between men with prostate cancer from a large follow-up study who died from the disease to those with no evidence of disease progression after at least 7 years of follow-up. METHODS Men diagnosed with prostate cancer in a large screening program were enrolled into a prospective follow-up study. From this population, we identified 134 men who died from prostate cancer, as confirmed using the National Death Index. As a comparison group, we identified 1033 prostate cancer cases with at least 7 years of follow-up and no disease recurrence. RESULTS As shown in Table 1, men who died from prostate cancer were significantly older and had significantly higher PSA levels at diagnosis. A greater proportion of men who died from prostate cancer had a suspicious DRE and a Gleason score of 7 to 10. Although less frequent, there were some prostate cancer deaths among men diagnosed with Gleason ≤6 prostate cancer in the screening study. Overall, men who died from prostate cancer had significantly fewer PSA tests and DREs prior to the diagnosis of prostate cancer, and had a significantly greater delay between abnormal screening results and follow-up biopsy. Death from Prostate Cancer (N=134) No Recurrence with At Least 7-year Follow-up (N=1033) p-value Median Age at Diagnosis (yrs) 70 (51-85) 65 (45-79) <0.0001 Median PSA (ng/mL) 6.5 (0.3-3373) 5.4 (0-82) <0.0001 No. of PSA Screenings Mean 4.0, Median 1.0 (1-23) Mean 5.4, Median 3.0 (1-22) 0.003 # DRE Mean 2.2, Median 1.0 (0-13) Mean 3.0, Median 2.0 (0-18) 0.0005 Last DRE Suspicious (%) 73/126 (58%) 283/953 (30%) <0.0001 Biopsy Gleason ≤6 51/104 (50%) 731/818 (89%) <0.0001 Days from abnormal screening test to 1st biopsy Mean 140, Median 40 (8-1532) (N=119) Mean 181, Median 42 (1-2885) (N=890) 0.26 CONCLUSIONS In this case-case analysis of men who died from prostate cancer compared to those who did not, disease-specific death was associated with a lower frequency of PSA and DRE testing. Men who died from prostate cancer also had a significantly greater delay in undergoing biopsy following abnormal test results, suggesting that this may be an important factor behind the negative findings of the PLCO trial. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e333 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua J. Meeks Chicago, IL More articles by this author Stacy Loeb Baltimore, MD More articles by this author Ronald Kim Chicago, IL More articles by this author Donghui Kan Chicago, IL More articles by this author Jessica A. Banks Chicago, IL More articles by this author Phillip R. Cooper Chicago, IL More articles by this author Brian T. Helfand Chicago, IL More articles by this author William J. Catalona Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...