2024-04-22 04:01:42
In a previous randomized trial that evaluated evidence for prostate specific antigen (PSA) for him prostate cancer, no effect of the detection of this biomarker on mortality from the pathology was reported at a median follow-up of 10 years. However, the long-term effects are unclear.
To evaluate the effect of a single invitation to PSA screening on prostate cancer mortality with a median follow-up of 15 years was the aim of this second part of the CAP study conducted by Dr. Richard M. Martin and his team from the Faculty of Medicine at the University of Bristol (UK ).
We included 408,721 men aged 50 to 69 years from 573 primary health care services in England and Wales. Of these, 189,326 participants received a single invitation to one PSA screening test, with subsequent diagnostic testing if the antigen level was 3.0 ng/ml or higher. The control group (n= 219,395) followed standard practice (without invitation). After 15 years, they assessed prostate cancer-specific mortality, all-cause mortality and pathological stage using Gleason grade at the time of diagnosis.
Prostate cancer was detected in 12,013 men in the intervention group and 12,958 in the control group (cumulative risk at 15 years, 7.08% and 6.94% [IC 95%]respectively). Among these, 1199 and 1451 died due to the pathology in the intervention and control groups respectively (P= 0.03). Eight deaths in the intervention group (0.7%) and seven in the control group (0.5%) were related to a diagnostic biopsy or treatment for the disease.
Compared to control, the PSA screening intervention increased the identification of low-grade neoplasia (Gleason score [GS] ≤6: 2.2% vs. 1.6%; P<0.001) and localized (T1/T2: 3.6% vs. 3.1%; P<0.001), but not intermediate (GS of 7), high-grade (GS ≥8), locally advanced (T3) or distal advanced ( T4/N1/M1). There were 45,084 deaths from all causes in the intervention group and 50,336 in the control (P= 0.11).
This secondary analysis shows that a single invitation to PSA screening reduces prostate cancer deaths over a median follow-up of 15 years, compared to standard practice without routine screening. However, the absolute reduction in deaths was small.
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