Prostate Cancer Mortality Among Elderly Men After Discontinuing Organised Screening: Long-term Results from the European Randomized Study of Screening for Prostate Cancer Rotterdam.
Eur Urol
; 85(1): 74-81, 2024 01.
Article
en En
| MEDLINE
| ID: mdl-37919190
ABSTRACT
BACKGROUND:
The optimal timing for discontinuing screening of prostate cancer (PCa) in elderly men is currently not known and remains debated.OBJECTIVE:
To assess prostate cancer-specific mortality (PCSM) in elderly men who previously underwent prostate-specific antigen (PSA)-based screening and to identify those who may benefit from continued screening. DESIGN, SETTING, ANDPARTICIPANTS:
A total of 7052 men, who participated in the screening arm of the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer and were aged 70-74 yr at their last screening visit after undergoing a maximum of three screening rounds without being diagnosed with PCa, were included. OUTCOME MEASUREMENTS AND STATISTICALANALYSIS:
The cumulative incidence of PCSM by the age of 85 yr was assessed. Additionally, a competing risk regression was performed to assess the potential predictors of PCSM. RESULTS ANDLIMITATIONS:
The median follow-up was 16 yr. The cumulative incidence of PCSM by the age of 85 yr was 0.54% (95% confidence interval [CI] 0.40-0.70) in all men, 0.11% (95% CI 0.05-0.27) in men with PSA <2 ng/ml, 0.85% (95% CI 0.47-1.5) in men with PSA 2-3 ng/ml, and 6.8% (95% CI 3.1-15) in men with PSA ≥6.5 ng/ml and no previous benign biopsy. PSA (subdistribution hazard ratio [sHR] 2.0; 95% CI 1.7-2.3), previous benign prostate biopsy (sHR 0.41; 95% CI 0.23-0.72), and hypertension (sHR 0.48; 95% CI 0.25-0.91) were significantly associated with PCSM.CONCLUSIONS:
Men aged 70-74 yr who have previously undergone PSA-based screening without receiving a PCa diagnosis have a very low risk of dying from PCa by the age of 85 yr. These data suggest that screening may be discontinued in men with PSA <3.0 ng/ml or previous benign prostate biopsies. Those with higher PSA levels and no prior biopsies may consider continued screening if life expectancy exceeds 10 yr. PATIENTSUMMARY:
This study shows that men who participated in a prostate cancer screening trial have a very low risk of dying from prostate cancer if they have not been diagnosed with prostate cancer by the age of 74 yr.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias de la Próstata
Límite:
Aged
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Aged80
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Humans
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Male
Idioma:
En
Revista:
Eur Urol
Año:
2024
Tipo del documento:
Article