March 16, 2012

Evaluating Prostate Cancer

(Ivanhoe Newswire)-- Prostate cancer is the most common cause of death from cancer in men over age 75. An 11 year study looked at death in men whom prostate cancer was diagnosed pre death and post death.

The study consisted of 182,160 men between the ages of 50 and 74 years at the start of the study, with a predefined core age group of 162,388 men 55 to 69 years of age. The trial was conducted in eight European countries.

Men who were randomly assigned to the screening group were offered PSA-based screening, whereas those in the control group were not offered such screening. The primary outcome was mortality from prostate cancer.

After a median follow-up of 11 years in the core age group, the relative reduction in the risk of death from prostate cancer in the screening group was 21% (rate ratio, 0.79; 95% confidence interval [CI], 0.68 to 0.91; P=0.001), and 29% after adjustment for noncompliance. The absolute reduction in mortality in the screening group was 0.10 deaths per 1000 person-years or 1.07 deaths per 1000 men who underwent randomization. The rate ratio for death from prostate cancer during follow-up years 10 and 11 was 0.62 (95% CI, 0.45 to 0.85; P=0.003). To prevent one death from prostate cancer at 11 years of follow-up, 1055 men would need to be invited for screening and 37 cancers would need to be detected. There was no significant between-group difference in all-cause mortality.

The total rate ratio for death from prostate cancer among men in the screening group was significantly below 1.00 in the core age group and for all ages. However, in the subgroup analyses, the rate ratio for death from prostate cancer was significant only for men between the ages of 65 and 69 years.

What researchers found was that after 2 additional years of follow-up consolidated our previous finding that PSA-based screening significantly reduced mortality from prostate cancer but did not affect all-cause mortality.

More information on the balance of benefits and adverse effects, as well as the cost-effectiveness, of prostate-cancer screening is needed before general recommendations can be made.

SOURCE: New England Medical Journal, March  2012.