All-Cause Mortality Risk in National Prostate Cancer Cohort: An Impact of Population-Based Prostate Cancer Screening.

Ausvydas Patasius,Giedre Smailyte

doi:10.3390/jcm10112459

Ausvydas Patasius, Giedre Smailyte

Open Access

https://doi.org/10.3390/jcm10112459

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Abstract

The aim of this study is to evaluate all-cause mortality risk differences before and during prostate cancer screening, with a profound focus on the differences between screened and not-screened patient groups. Prostate cancer cases diagnosed between 1998 and 2016 were identified from the population-based Lithuanian Cancer Registry and linked with screening status in the National Health Insurance Fund database. The analysis was stratified by a period of diagnosis and screening status. Standardized mortality ratios (SMRs) were used to assess all-cause and cause-specific mortality risk. The SMRs were calculated by dividing the observed number of deaths among prostate cancer patients by the expected number of deaths from the general population. All-cause SMR (1.45 (95% CI 1.42–1.48)) in the pre-screening period was higher compared to the screening period (SMR = 1.17 (95% CI 1.15–1.19)). An increased all-cause mortality risk among prostate cancer patients was observed in the not-screened patient population (SMR = 1.76 (95% CI 1.71–1.82)), while all-cause mortality risk in the screened patient population was similar to the general population (SMR = 1.00 (95% CI 0.97–1.02)). Screened patients with localized stage of disease had lower all-cause mortality risk than the general population (SMR = 0.72 (95% CI 0.70–0.75)). In conclusion, men with prostate cancer in Lithuania had excess all-cause mortality risk compared to the general population. The all-cause mortality risk among screened patients was not higher than expected.

Highlights

The purpose of this study is to evaluate all-cause and other cause mortality risk differences before and during prostate cancer screening, with a profound focus on all-cause mortality risk differences between screened and not-screened patient groups
The study cohort was divided into two periods: Patients diagnosed with prostate cancer before the official start date of prostate cancer screening 1 January 2006 were assigned to the group “pre-screening”, and patients diagnosed after 1 January 2006 assigned to group the “screening”
All-cause mortality risk before and during the screening period (Table 2, part A) among prostate cancer patients was higher compared to the general population, during screening period all-cause mortality risk was lower than in the pre-screening period (SMR = 1.45 vs. Standardized mortality ratios (SMRs) = 1.17)

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The main factor determining the incidence of prostate cancer is the utilization of prostate specific antigen (PSA) test in clinical practice and public health interventions [1]. Despite the wide use of PSA testing in many countries, the benefits of PSA-based screening remain debatable [2]. The best indicator for success against cancer is a decreasing mortality rate in the population [3]. European randomized study of screening for Prostate

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