Prostate cancer specific survival in the Prostate,Lung, Colorectal,and Ovarian (PLCO) Cancer Screening Trial |
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| Authors: | Paul F. Pinsky Amanda Black Howard L. Parnes Robert Grubb E. David Crawford Anthony Miller Douglas Reding Gerald Andriole |
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| Affiliation: | 1. Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States;2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States;3. Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, United States;4. University of Colorado, Denver, Denver, CO, United States;5. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada;6. Marshfield Clinic, Marshfield, WI, United States;1. Division of Urologic Oncology, the Center for Cancer Prevention and Treatment at St. Joseph Hospital, Orange, California;2. Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California;3. Division of Urologic Surgery, Brigham and Women''s Hospital, Boston, Massachusetts;4. Center for Surgery and Public Health, Brigham and Women''s Hospital, Boston, Massachusetts;5. Department of Radiation Oncology, Brigham and Women''s Hospital, Boston, Massachusetts;1. Servicio de Urología, Hospital Universitario Infanta Cristina, Universidad Complutense de Madrid, Parla, Madrid, Spain;2. Servicio de Urología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, Spain;3. Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain;4. Servicio de Urología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain;5. Servicio de Urología, Hospital Universitario Madrid Norte Sanchinarro, Universidad CEU San Pablo, Madrid, Spain;1. Department of Urology, New York University, New York, New York;2. Population Health, New York University, New York, New York;3. Laura and Isaac Perlmutter Cancer Center, New York University, New York, New York;1. Division of Urology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada;2. Department of Medical Imaging, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada;3. Department of Pathology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada;1. The Dean and Betty Gallo Prostate Cancer Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey;2. Cancer Institute of New Jersey, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey;3. Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey;4. Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey;5. Department of Biostatistics, School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey;6. Smith Hanley Consulting Group, Bryn Mawr, Pennsylvania |
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| Abstract: | Background: The prostate component of the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized screening trial demonstrated no mortality effect of screening. Here we analyze prostate cancer specific survival in PLCO and its relation to screening. Methods: 76,693 men aged 55–74 were randomized to usual care (n = 38,350) or intervention (n = 38,343). Intervention arm men received annual prostate-specific antigen (6 years) and digital rectal exam (4 years). Men were followed for cancer diagnosis and mortality through 13 years. Medical record abstractors confirmed prostate cancer diagnoses, stage and grade. Prostate-specific survival in PLCO cases was analyzed using Kaplan–Meier analysis and proportional hazards modeling. We utilized data from the Surveillance, Epidemiology and End Results (SEER) program to compute expected survival in PLCO and compared this to observed. Results: There was no significant difference in prostate-specific survival rates between arms; 10 year survival rates were 94.7% (intervention, n = 4250 cases) versus 93.5% (usual care, n = 3815 cases). Within the intervention arm, cases never screened in PLCO had lower 10 year survival rates (82%) than screen detected or interval (following a negative screen) cases, both around 95.5%. The ratio of observed to expected 10 year prostate-specific death (1-survival) rates was 0.59 (95% CI: 0.51–0.68) for all PLCO cases, 0.66 (95% CI: 0.51–0.81) for Gleason 5–7 cases and 1.07 (95% CI: 0.87–1.3) for Gleason 8–10 cases. Conclusion: Prostate cancer specific survival in PLCO was comparable across arms and significantly better than expected based on nationwide population data. How much of the better survival is due to a healthy volunteer effect and to lead-time and overdiagnosis biases is not readily determinable. |
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