ONCOmmunity

Long-term outcome of a single intervention Population based Prostate Cancer Screening Study.

By: Per-Olof Lundgren, Anders Kjellman, Ulf Norming, Ove Gustafsson

Department of clinical science, intervention and technology, Karolinska Institutet, Stockholm, Sweden. Electronic address: per-olof.lundgren@sll.se.
2018-01-20; doi: 10.1016/j.juro.2018.01.080

Abstract

Purpose

To evaluate long term effect of screening for prostate cancer.

Materials

In 1988, 2400 men were randomly selected from a background population of 27 464 men. 2400 men were invited to undergo screening. 1779 men (74%) accepted the invitation and were examined with digital rectal examination, ultrasound and prostate specific antigen levels. Biopsies were performed if suspicious findings on ultrasound or rectal exam were present or if PSA > 10 ng/mL. The sub-populations have now been re-assessed after 20 years.

Results

The participants had a decreased overall mortality rate compared to the source population: IRR (95%CI): 0.93 (0.86-0.98). The non-participants had an increased overall mortality rate IRR (95%CI): 1.25 (1.14-1.37). There was no difference between the groups with regard to prostate cancer specific survival. The incidence of prostate cancer remained higher in the screened population throughout the follow-up period.

Conclusion

A single screening intervention in men aged 50-75 years using PSA, DRE and TRUS and a PSA cut-off for biopsies at 10 ng/mL carried a significant risk of prostate cancer detection without a concomitant reduction in prostate cancer specific mortality after 20 years and should not be considered for public screening. Non-participants were at a larger risk of death from all causes. In addition to being a single intervention trial, limitations to this study include out-dated PSA cut off-levels for biopsies. Despite outdated screening method, the source population fails to reach the same level of prostate cancer incidence as the screened population, even after 20 years.