Overall adaptation ability be the amiss end point to use back it comes to prostate blight screening, according to a fresh abstraction that begin that screening decreases the accident of metastatic disease. Many patients with prostate blight alive continued lives and die of added causes, so appulse on metastatic ache ability be a more good way to appearance the allowances of prostate screening, say the authors. The abatement in the accident of metastatic ache ability beforehand affection of activity and advice lower the bread-and-butter accountability associated with analysis and affliction for patients with avant-garde prostate cancer, explained beforehand abstraction columnist Chandana Reddy, MS, chief biostatistician at the Cleveland Clinic in Ohio. She presented her allegation at a columnist conference captivated in beforehand of the American Society for Radiation Oncology (ASTRO) 52nd Annual Meeting. “Screening is a huge adventure and one of the better questions in anesthetic today,” said Anthony L. Zietman, MD, admiral of ASTRO and adjudicator of the briefing. “It leads to abundant anxiety, abounding accidental biopsies, and abundant overdiagnosis of actual aboriginal cancers, which may charge no analysis at all.” Dr. Zietman, who is the Jenot and William Shipley Professor of Radiation Oncology at Harvard Medical School in Boston, Massachusetts, acicular out that “screening would be account it if we could actualize it as actuality able to accompany bottomward the blight afterlife rate.” Opinions amid able societies and organizations are acutely split, he noted. “The American Urologic Society is foolishly in favor of screening, while the US Preventive Services Task Force is against to screening,” he said. “And the American Blight Society is sitting durably on the fence.”
Wrong End Point?
Routine prostate cancer screening was implemented in 1993 with the prostate-specific antigen (PSA) test. There have been 2 recent studies that demonstrated no benefit to screening with respect to overall survival, said Ms. Reddy, although there have been European studies that did report a survival benefit. “One possible explanation for the lack of benefit is that they used the wrong end point — namely overall survival,” she said. Because metastatic disease is essentially incurable, the best measure of screening effectiveness might not be overall survival, but instead its ability to lessen the metastatic disease burden of the screened population, Ms. Reddy explained. “This is a cancer primarily of older men who may have other medical problems, and the screening benefit may be masked by the fact that these men will die of something other than prostate cancer,” she noted. “Our hypothesis was that the best way to measure the efficacy of screening was to see if it had any ability to reduce the rate of metastatic disease following treatment,” Ms. Reddy said during the briefing. “Our study looked at the end point of metastatic disease.”
Lower Metastases Rates in “Post” Group
From 1986 to 1996, 1721 patients with prostate cancer were definitively treated with radical prostatectomy or radiotherapy at the Cleveland Clinic. To evaluate the impact of screening on this population, patients were divided into a prescreening-era group, consisting of those treated from 1986 to 1992 (n = 575), and a postscreening-era group, consisting of patients treated from 1993 to 1996 (n = 1146). Patients still at risk for recurrence beyond 10 years were censored at 10 years to remove the potential for an imbalance in follow-up time between the 2 study groups. The median follow-up was 10 years (range, 0.1 to 10); among prescreening-era patients, 44% were considered high risk, 21% intermediate risk, and 28% low risk. Among postscreening-era patients, 36% were considered high risk, 27% intermediate risk, and 37% low risk. The authors observed that within 10 years of treatment, 13% of all patients had developed metastatic disease. The 10-year metastases-free survival rates for high-risk patients in the prescreening-era group was 58%, and in the potscreening-era group was 82% (P < .0001). For intermediate risk, it was 79% vs 93% (P < .0001), and for low risk, it was 90% vs 98% (P = .0001). On univariate analysis, the factors that were found to be significantly associated (P < .05) with metastatic disease within 10 years of treatment were screening era, age, T stage, PSA value before treatment, and biopsy Gleason score. On multivariable analysis, only screening era (hazard ratio, 3.5, 95% confidence interval, 2.6 – 4.6), T stage, and biopsy Gleason score remained significant. The data show that within each of the 3 defined risk groups, explained Ms. Reddy, men treated in the prescreening era were significantly more likely to develop metastatic disease within 10 years of treatment than those treated in the postscreening era