Extended follow‐up for prostate cancer incidence and mortality among participants in the Prostate, Lung, Colorectal and Ovarian randomized cancer screening trial
Objective To examine prostate cancer (PCa) incidence and mortality by arm in the randomized Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial. Patients and Methods Patients aged 55–74 years at 10 screening centres were randomized between 1993 and 2001 to an intervention or usual c...
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| Veröffentlicht in: | BJU international 2019-05, Vol.123 (5), p.854-860 |
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| creator | Pinsky, Paul F. Miller, Eric Prorok, Philip Grubb, Robert Crawford, E. David Andriole, Gerald |
| description | Objective
To examine prostate cancer (PCa) incidence and mortality by arm in the randomized Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial.
Patients and Methods
Patients aged 55–74 years at 10 screening centres were randomized between 1993 and 2001 to an intervention or usual care arm. Patients in the intervention arm received six annual prostate‐specific antigen (PSA) tests and four annual digital rectal examinations. The patients were followed for PCa incidence and for mortality via active follow‐up processes and by linkage to state cancer registries and the National Death Index. For cancers identified through active follow‐up, trial ors recorded the mode of diagnosis (screen‐detected, symptomatic, other).
Results
A total of 38 340 patients were randomized to the intervention arm and 38 343 to a usual care arm. The median follow‐up for mortality was 16.9 (intervention) and 16.7 years (usual care). There were 333 (intervention) and 352 (usual care) PCa cancer deaths, giving rates (per 10 000 person‐years) of 5.5 and 5.9, respectively, and a rate ratio (RR) of 0.93 (95% confidence interval [CI] 0.81–1.08; P = 0.38). The RR for overall PCa incidence was 1.05 (95% CI 1.01–1.09). The RRs by Gleason category were 1.17 (95% CI 1.11–1.23) for Gleason 2–6, 1.00 (95% CI 0.93–1.07) for Gleason 7 and 0.89 (95% CI 0.80–0.99) for Gleason 8–10 disease. By mode of detection, during the trial's screening phase, 13% of intervention arm vs 27% of usual care arm cases were symptomatic; post‐screening, these percentages were 18% in each arm.
Conclusion
After almost 17 years of median follow‐up, there was no significant reduction in PCa mortality in the intervention compared with the usual care arm. There was a significant increase in Gleason 2–6 disease and a significant reduction in Gleason 8–10 disease in the intervention compared with the usual care arm. |
| doi_str_mv | 10.1111/bju.14580 |
| format | Article |
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To examine prostate cancer (PCa) incidence and mortality by arm in the randomized Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial.
Patients and Methods
Patients aged 55–74 years at 10 screening centres were randomized between 1993 and 2001 to an intervention or usual care arm. Patients in the intervention arm received six annual prostate‐specific antigen (PSA) tests and four annual digital rectal examinations. The patients were followed for PCa incidence and for mortality via active follow‐up processes and by linkage to state cancer registries and the National Death Index. For cancers identified through active follow‐up, trial ors recorded the mode of diagnosis (screen‐detected, symptomatic, other).
Results
A total of 38 340 patients were randomized to the intervention arm and 38 343 to a usual care arm. The median follow‐up for mortality was 16.9 (intervention) and 16.7 years (usual care). There were 333 (intervention) and 352 (usual care) PCa cancer deaths, giving rates (per 10 000 person‐years) of 5.5 and 5.9, respectively, and a rate ratio (RR) of 0.93 (95% confidence interval [CI] 0.81–1.08; P = 0.38). The RR for overall PCa incidence was 1.05 (95% CI 1.01–1.09). The RRs by Gleason category were 1.17 (95% CI 1.11–1.23) for Gleason 2–6, 1.00 (95% CI 0.93–1.07) for Gleason 7 and 0.89 (95% CI 0.80–0.99) for Gleason 8–10 disease. By mode of detection, during the trial's screening phase, 13% of intervention arm vs 27% of usual care arm cases were symptomatic; post‐screening, these percentages were 18% in each arm.
Conclusion
After almost 17 years of median follow‐up, there was no significant reduction in PCa mortality in the intervention compared with the usual care arm. There was a significant increase in Gleason 2–6 disease and a significant reduction in Gleason 8–10 disease in the intervention compared with the usual care arm.</description><identifier>ISSN: 1464-4096</identifier><identifier>ISSN: 1464-410X</identifier><identifier>EISSN: 1464-410X</identifier><identifier>DOI: 10.1111/bju.14580</identifier><identifier>PMID: 30288918</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Aged ; Biomarkers, Tumor - blood ; Cancer screening ; Digital Rectal Examination - statistics & numerical data ; Early Detection of Cancer - statistics & numerical data ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mass Screening ; Medical screening ; Middle Aged ; Mortality ; Ovarian cancer ; PCSM ; Prostate cancer ; Prostate-Specific Antigen - blood ; ProstateCancer ; prostate‐specific antigen ; Prostatic Neoplasms - diagnosis ; Prostatic Neoplasms - mortality ; Rectum ; screening ; uroonc</subject><ispartof>BJU international, 2019-05, Vol.123 (5), p.854-860</ispartof><rights>2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.</rights><rights>BJUI © 2019 BJU International</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3880-3b90598b11ad56e1d0b0cd26d85896b9972fc265ef7e225d972386c64b6f0e4c3</citedby><cites>FETCH-LOGICAL-c3880-3b90598b11ad56e1d0b0cd26d85896b9972fc265ef7e225d972386c64b6f0e4c3</cites><orcidid>0000-0002-1946-1048 ; 0000-0002-0350-3282</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fbju.14580$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fbju.14580$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30288918$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pinsky, Paul F.</creatorcontrib><creatorcontrib>Miller, Eric</creatorcontrib><creatorcontrib>Prorok, Philip</creatorcontrib><creatorcontrib>Grubb, Robert</creatorcontrib><creatorcontrib>Crawford, E. David</creatorcontrib><creatorcontrib>Andriole, Gerald</creatorcontrib><title>Extended follow‐up for prostate cancer incidence and mortality among participants in the Prostate, Lung, Colorectal and Ovarian randomized cancer screening trial</title><title>BJU international</title><addtitle>BJU Int</addtitle><description>Objective
To examine prostate cancer (PCa) incidence and mortality by arm in the randomized Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial.
Patients and Methods
Patients aged 55–74 years at 10 screening centres were randomized between 1993 and 2001 to an intervention or usual care arm. Patients in the intervention arm received six annual prostate‐specific antigen (PSA) tests and four annual digital rectal examinations. The patients were followed for PCa incidence and for mortality via active follow‐up processes and by linkage to state cancer registries and the National Death Index. For cancers identified through active follow‐up, trial ors recorded the mode of diagnosis (screen‐detected, symptomatic, other).
Results
A total of 38 340 patients were randomized to the intervention arm and 38 343 to a usual care arm. The median follow‐up for mortality was 16.9 (intervention) and 16.7 years (usual care). There were 333 (intervention) and 352 (usual care) PCa cancer deaths, giving rates (per 10 000 person‐years) of 5.5 and 5.9, respectively, and a rate ratio (RR) of 0.93 (95% confidence interval [CI] 0.81–1.08; P = 0.38). The RR for overall PCa incidence was 1.05 (95% CI 1.01–1.09). The RRs by Gleason category were 1.17 (95% CI 1.11–1.23) for Gleason 2–6, 1.00 (95% CI 0.93–1.07) for Gleason 7 and 0.89 (95% CI 0.80–0.99) for Gleason 8–10 disease. By mode of detection, during the trial's screening phase, 13% of intervention arm vs 27% of usual care arm cases were symptomatic; post‐screening, these percentages were 18% in each arm.
Conclusion
After almost 17 years of median follow‐up, there was no significant reduction in PCa mortality in the intervention compared with the usual care arm. There was a significant increase in Gleason 2–6 disease and a significant reduction in Gleason 8–10 disease in the intervention compared with the usual care arm.</description><subject>Aged</subject><subject>Biomarkers, Tumor - blood</subject><subject>Cancer screening</subject><subject>Digital Rectal Examination - statistics & numerical data</subject><subject>Early Detection of Cancer - statistics & numerical data</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Mass Screening</subject><subject>Medical screening</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Ovarian cancer</subject><subject>PCSM</subject><subject>Prostate cancer</subject><subject>Prostate-Specific Antigen - blood</subject><subject>ProstateCancer</subject><subject>prostate‐specific antigen</subject><subject>Prostatic Neoplasms - diagnosis</subject><subject>Prostatic Neoplasms - mortality</subject><subject>Rectum</subject><subject>screening</subject><subject>uroonc</subject><issn>1464-4096</issn><issn>1464-410X</issn><issn>1464-410X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1uFSEUx4nR2Fpd-AKGxI0mvS3MB4Wl3tRac5O6sIk7wsCZys0MjMBYrysfwXfwzfoknvbeujCRDeeQHz8-_oQ85-yI4zju1vMRb1rJHpB93ohm0XD2-eF9zZTYI09yXjOGC6J9TPZqVkmpuNwnv0-_FwgOHO3jMMTrm5-_5gnrRKcUczEFqDXBQqI-WO8AS2qCo2NMxQy-bKgZY7iik0nFWz-ZUDKitHwB-nFnOKSrOVwd0mUcYgKL--4UF99M8ibQhE0c_Q-8w-6obBNA8KgtSAxPyaPeDBme7eYDcvnu9NPy_WJ1cXa-fLNa2FpKtqg7xVolO86NawVwxzpmXSWcbKUSnVInVW8r0UJ_AlXVOuxrKaxoOtEzaGx9QF5tvfj0rzPkokefLQyDCRDnrCvOhWyZ4gLRl_-g6zingLfTFWKKM64qpF5vKYs_kRP0ekp-NGmjOdO3yWlMTt8lh-yLnXHuRnB_yfuoEDjeAtd-gM3_Tfrth8ut8g-JgaW1</recordid><startdate>201905</startdate><enddate>201905</enddate><creator>Pinsky, Paul F.</creator><creator>Miller, Eric</creator><creator>Prorok, Philip</creator><creator>Grubb, Robert</creator><creator>Crawford, E. David</creator><creator>Andriole, Gerald</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1946-1048</orcidid><orcidid>https://orcid.org/0000-0002-0350-3282</orcidid></search><sort><creationdate>201905</creationdate><title>Extended follow‐up for prostate cancer incidence and mortality among participants in the Prostate, Lung, Colorectal and Ovarian randomized cancer screening trial</title><author>Pinsky, Paul F. ; Miller, Eric ; Prorok, Philip ; Grubb, Robert ; Crawford, E. David ; Andriole, Gerald</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3880-3b90598b11ad56e1d0b0cd26d85896b9972fc265ef7e225d972386c64b6f0e4c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Biomarkers, Tumor - blood</topic><topic>Cancer screening</topic><topic>Digital Rectal Examination - statistics & numerical data</topic><topic>Early Detection of Cancer - statistics & numerical data</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Mass Screening</topic><topic>Medical screening</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Ovarian cancer</topic><topic>PCSM</topic><topic>Prostate cancer</topic><topic>Prostate-Specific Antigen - blood</topic><topic>ProstateCancer</topic><topic>prostate‐specific antigen</topic><topic>Prostatic Neoplasms - diagnosis</topic><topic>Prostatic Neoplasms - mortality</topic><topic>Rectum</topic><topic>screening</topic><topic>uroonc</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pinsky, Paul F.</creatorcontrib><creatorcontrib>Miller, Eric</creatorcontrib><creatorcontrib>Prorok, Philip</creatorcontrib><creatorcontrib>Grubb, Robert</creatorcontrib><creatorcontrib>Crawford, E. David</creatorcontrib><creatorcontrib>Andriole, Gerald</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>BJU international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pinsky, Paul F.</au><au>Miller, Eric</au><au>Prorok, Philip</au><au>Grubb, Robert</au><au>Crawford, E. David</au><au>Andriole, Gerald</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extended follow‐up for prostate cancer incidence and mortality among participants in the Prostate, Lung, Colorectal and Ovarian randomized cancer screening trial</atitle><jtitle>BJU international</jtitle><addtitle>BJU Int</addtitle><date>2019-05</date><risdate>2019</risdate><volume>123</volume><issue>5</issue><spage>854</spage><epage>860</epage><pages>854-860</pages><issn>1464-4096</issn><issn>1464-410X</issn><eissn>1464-410X</eissn><abstract>Objective
To examine prostate cancer (PCa) incidence and mortality by arm in the randomized Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial.
Patients and Methods
Patients aged 55–74 years at 10 screening centres were randomized between 1993 and 2001 to an intervention or usual care arm. Patients in the intervention arm received six annual prostate‐specific antigen (PSA) tests and four annual digital rectal examinations. The patients were followed for PCa incidence and for mortality via active follow‐up processes and by linkage to state cancer registries and the National Death Index. For cancers identified through active follow‐up, trial ors recorded the mode of diagnosis (screen‐detected, symptomatic, other).
Results
A total of 38 340 patients were randomized to the intervention arm and 38 343 to a usual care arm. The median follow‐up for mortality was 16.9 (intervention) and 16.7 years (usual care). There were 333 (intervention) and 352 (usual care) PCa cancer deaths, giving rates (per 10 000 person‐years) of 5.5 and 5.9, respectively, and a rate ratio (RR) of 0.93 (95% confidence interval [CI] 0.81–1.08; P = 0.38). The RR for overall PCa incidence was 1.05 (95% CI 1.01–1.09). The RRs by Gleason category were 1.17 (95% CI 1.11–1.23) for Gleason 2–6, 1.00 (95% CI 0.93–1.07) for Gleason 7 and 0.89 (95% CI 0.80–0.99) for Gleason 8–10 disease. By mode of detection, during the trial's screening phase, 13% of intervention arm vs 27% of usual care arm cases were symptomatic; post‐screening, these percentages were 18% in each arm.
Conclusion
After almost 17 years of median follow‐up, there was no significant reduction in PCa mortality in the intervention compared with the usual care arm. There was a significant increase in Gleason 2–6 disease and a significant reduction in Gleason 8–10 disease in the intervention compared with the usual care arm.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30288918</pmid><doi>10.1111/bju.14580</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-1946-1048</orcidid><orcidid>https://orcid.org/0000-0002-0350-3282</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged Biomarkers, Tumor - blood Cancer screening Digital Rectal Examination - statistics & numerical data Early Detection of Cancer - statistics & numerical data Follow-Up Studies Humans Incidence Male Mass Screening Medical screening Middle Aged Mortality Ovarian cancer PCSM Prostate cancer Prostate-Specific Antigen - blood ProstateCancer prostate‐specific antigen Prostatic Neoplasms - diagnosis Prostatic Neoplasms - mortality Rectum screening uroonc |
| title | Extended follow‐up for prostate cancer incidence and mortality among participants in the Prostate, Lung, Colorectal and Ovarian randomized cancer screening trial |
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