Prostate cancer incidence and mortality in the Spanish section of the European Randomized Study of Screening For Prostate Cancer (ERSPC)
Menée sur 4 276 hommes espagnols d'âge compris entre 45 et 70 ans (durée médiane de suivi : 15,2 ans), cette étude présente les résultats à long terme d'un essai sur l'intérêt d'un dépistage du cancer de la prostate à l'aide de la mesure du PSA
BACKGROUND: To present the long-term results of a prostate cancer (PC) screening trial conducted in a Mediterranean setting.
METHODS: A total of 4276 men aged 45–70 years were randomized to screening arm (PSA test performed) and control arm (no tests). Transrectal ultrasonography-guided sextant prostate biopsy was conducted when PSAgreater than or equal to3 ng ml−1. Date and cause of death were retrieved from death certificates. PC incidence, and disease-specific and overall mortality curves were plotted and comparison between arms was made. Analysis of causes of death was also performed.
RESULTS: Median age at randomization was 57.0 years. Median follow-up time was 15.2 years. A total of 241 men were diagnosed with PC, 161 (6.7%) in the screening arm and 80 (4.3%) in the control arm (P<0.01). Eventually, 554 men (13%) died. No difference in all-cause mortality was found between arms (P=0.34). Only 10 men (10/4276, 0.23%) died from PC, no differences between arms (P=0.67). Overall, the main causes of death were malignancy (54.2%), cardiovascular (17.9%) and respiratory (9.2%) diseases. Main cancer causes of death were lung and bronchus cancer (37.2%), colorectum (15.0%) and stomach (9.0%) cancer. PC only accounted for 3.0% of all malignant causes of death (ranked 10th).
CONCLUSIONS: Our study failed to demonstrate benefits of PC screening in terms of all-cause and PC-specific mortality after a median follow-up of 15 years. The limited sample size and the low long-term PC mortality observed in our setting were probably the most important factors to explain these results.
Prostate Cancer and Prostatic Diseases , résumé, 2013