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Keywords:

  • prostate cancer;
  • mortality;
  • risk;
  • screening;
  • PSA;
  • early detection

Study Type – Prognosis (case control)

Level of Evidence 3a

What's known on the subject? and What does the study add?

Treatment of advanced PC might put patients at an increased risk of cardiovascular events. Recent studies have suggested that the excess mortality is lower among men who were diagnosed with screen detected PC in comparison to men with clinically diagnosed PC, possibly due to the use of medications for cardiovascular disease and the change to a healthier lifestyle of men with a screen detected PC.

Men with clinically diagnosed PC have an increased risk of death unrelated to PC itself, i.e., the excess mortality is based on an increased risk of dying from other neoplasm and diseases of the circulatory or respiratory system.

OBJECTIVE

  • • 
    To assess the cause-specific mortality unrelated to prostate cancer (PC) itself in patients with screen- and clinically diagnosed PC.

PATIENTS AND METHODS

  • • 
    The present study was conducted among participants of the European Randomized Study of Screening for Prostate Cancer.
  • • 
    Based on consensus of the causes of death committee (CODC), all patients who died from PC were excluded.
  • • 
    In the intervention arm, cases were patients with a screen-detected PC, aged 55–74 years, between 1993 and 2001.
  • • 
    These cases were matched to two controls in whom no cancer was found after biopsy, and two controls in whom no cancer was suspected after screening. In the control arm, cases were patients with clinically diagnosed PC, aged 55–74 years, between 1993 and 2001. These cases were matched to four controls without PC. Matching was done with respect to date of birth, screening and/or diagnosis. Men were followed up to 31 December 2007.

RESULTS

  • • 
    No statistically significant difference in overall mortality between cases and controls in the intervention arm was observed: relative risk (RR) 1.26 (95% confidence interval [CI] 0.96–1.65; P = 0.102) and RR 1.13 (95% CI 0.86–1.47; P = 0.381).
  • • 
    In the control arm, the overall mortality was statistically significantly higher in cases relative to controls: RR 1.43 (95% CI 1.03–2.00; P = 0.033).
  • • 
    This difference was because of an increased risk of dying from neoplasms and disease of the circulatory or respiratory system among cases: RR 1.61 (95% CI 1.12–2.29; P = 0.009).
  • • 
    The present study was limited by the relatively small sample size.

CONCLUSIONS

  • • 
    Increased mortality unrelated to PC itself was observed in men with clinically diagnosed PC, but not in screen-detected PC.
  • • 
    The excess mortality in men with clinically diagnosed PC seems to be as a result of a significantly increased risk of dying from neoplasm and disease of the circulatory or respiratory system.
  • • 
    Results have to be studied more thoroughly in further clinical trials.