More intensive prostate cancer screening and treatment is not linked with fewer prostate cancer deaths
Early in the prostate-specific antigen (PSA) screening era for prostate cancer (1987 to 1990), men in the Seattle area were screened and treated for prostate cancer more intensively than men in Connecticut. Yet, this intensive approach did not translate into fewer deaths from prostate cancer 15 years later, according to a new study. Until results of randomized trials become available, shared decisionmaking regarding PSA screening should continue between clinicians and patients, recommend the study authors.
The authors examined rates of prostate cancer screening; treatment with radical prostatectomy, external beam radiotherapy, and androgen deprivation therapy; and prostate cancer-specific mortality among Medicare-insured men ages 65-79 from Seattle and Connecticut. Men in both areas had similar prostate cancer mortality rates prior to introduction of the PSA test.
The 15-year cumulative incidences of radical prostatectomy and radiotherapy through 2001 were 2.84 and 6.02 percent, respectively, for Seattle men compared to 0.56 and 5.07 percent for Connecticut men. The cumulative incidence of androgen deprivation therapy from 1991-2001 was 4.78 percent for Seattle men compared to 6.13 percent for Connecticut men. The rate of prostate cancer mortality through 2001 was equal, after adjustment for other factors. The study was supported by the Agency for Healthcare Research and Quality (HS08397 and HS10278).
More details are in "Screening, treatment, and prostate cancer mortality in the Seattle area and Connecticut: Fifteen-year follow-up," by Grace Lu-Yao, Ph.D., Peter C. Albertsen, M.D., Janet L. Stanford, Ph.D., and others, in the November 2008 Journal of General Internal Medicine 23(11), pp. 1809-1814.
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