Abstract
ABSTRACTPurpose:Prostate cancer screening in the elderly is controversial. The Brazilian government and the National Cancer Institute (INCA) do not recommend systematic screening. Our purpose was to assess prevalence and aggressiveness of prostate cancer in men aged 70 years and above, on the first Latin American database to date.Materials and Methods:Cross-sectional study (n=17,571) from 231 municipalities, visited by Mobile Cancer Prevention Units of a prostate-specific antigen (PSA) based opportunistic screening program, between 2004 and 2007. The criteria for biopsy were: PSA>4.0ng/ml, or PSA 2.5-4.0ng/ml with free/total PSA ratio ≤15%, or suspicious digital rectal examination findings. The screened men were stratified in two age groups (45-69 years, and ≥70 years). These groups were compared regarding prostate cancer prevalence and aggressiveness criteria (PSA, Gleason score from biopsy and TNM staging).Results:The prevalence of prostate cancer found was 3.7%. When compared to men aged 45-69 years, individuals aged 70 years and above presented cancer prevalence about three times higher (prevalence ratio 2.9, p<0.01), and greater likelihood to present PSA level above 10.0ng/ml at diagnosis (odds ratio 2.63, p<0.01). The group of elderly men also presented prevalence of histologically aggressive disease (Gleason 8-10) 3.6 times higher (p<0.01), and 5-fold greater prevalence of metastases (PR 4.95, p<0.05).Conclusions:Prostate cancer screening in men aged over 70 may be relevant in Brazil, considering the absence of systematic screening, higher prevalence and higher probability of high-risk disease found in this age range of the population studied.
Highlights
Prostate cancer (PCa) is a major issue in cancer incidence and mortality worldwide [1]
To test the hypothesis that elderly men of a Brazilian population not exposed to previous systematic screening have increased prevalence of prostate cancer and worse aggressiveness criteria at diagnosis, compared to younger men
We performed an analysis on the database of the Mobile Cancer Prevention Units (MCPU) program [14], which visited 231 cities of six Brazilians states between 2004 and 2007, including 17.571 volunteers for prostate-specific antigen (PSA)-based PCa screening, aged ≥45 years
Summary
Prostate cancer (PCa) is a major issue in cancer incidence and mortality worldwide [1]. In the United States of America (USA), the Surveillance, Epidemiology and End Results Program (SEER) data estimated 161.360 new cases of PCa in 2017 (incidence rate 119.8/100.000) [2]. The effects of prostate-specific antigen (PSA) screening on mortality are controversial. The European Randomized Study of Screening for Prostate Cancer (ERSPC) found a 27% relative reduction in PCa mortality in the intervention arm [4]. The Prostate, Lung, Colorectal and Ovarian cancer screening study (PLCO) found no benefits [5]. Recent analyses on these data reported PLCO methodological flaws, dismissing its capability of evaluating systematic screening effectiveness. There is consensus among medical entities about performing PCa screening only in individuals with life expectancy superior to 10 years [7,8,9], due to the long cancer-specific survival after the diagnosis of localized disease [10]
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