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Keywords:

  • screening;
  • radical prostatectomy;
  • survival;
  • prostate-specific antigen;
  • biochemical progression;
  • mortality

Study Type – Therapy (cohort)

Level of Evidence 2b

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

Radical prostatectomy was previously shown to improve long-term outcomes among men with clinically-detected prostate cancer. Our data suggests that radical prostatectomy is also associated with improved outcomes in men with screen-detected prostate cancer.

OBJECTIVE

  • • 
    To examine the long-term outcomes of radical prostatectomy (RP) among men diagnosed with prostate cancer from the screening and control arms of the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer (ERSPC).

PATIENTS AND METHODS

  • • 
    Among 42 376 men randomised during the period of the first round of the trial (1993–1999), 1151 and 210 in the screening and control arms were diagnosed with prostate cancer, respectively.
  • • 
    Of these men, 420 (36.5%) screen-detected and 54 (25.7%) controls underwent RP with long-term follow-up data (median follow-up 9.9 years).
  • • 
    Progression-free (PFS), metastasis-free (MFS) and cancer-specific survival (CSS) rates were examined, and multivariable Cox proportional hazards models were used to determine whether screen-detected (vs control) was associated with RP outcomes after adjusting for standard predictors.

RESULTS

  • • 
    RP cases from the screening and control arms had statistically similar clinical stage and biopsy Gleason score, although screen-detected cases had significantly lower prostate-specific antigen (PSA) levels at diagnosis.
  • • 
    Men from the screening arm had a significantly higher PFS (P= 0.003), MFS (P < 0.001) and CSS (P= 0.048).
  • • 
    In multivariable models adjusting for age, PSA level, clinical stage, and biopsy Gleason score, the screening group had a significantly lower risk of biochemical recurrence (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.23–0.83, P= 0.011) and metastasis (HR 0.18, 95% CI 0.06–0.59, P= 0.005).
  • • 
    Additionally adjusting for tumour volume and other RP pathology features, there was no longer a significant difference in biochemical recurrence between the screening and control arms.
  • • 
    Limitations of the present study include lead-time bias and non-randomised treatment selection.

CONCLUSIONS

  • • 
    After RP, screen-detected cases had significantly improved PFS, MFS and CSS compared with controls within the available follow-up time.
  • • 
    The screening arm remained significantly associated with lower rates of biochemical recurrence and metastasis after adjusting for other preoperative variables.
  • • 
    However, considering also RP pathology, the improved outcomes in the screening group appeared to be mediated by a significantly lower tumour volume.