Screening and treatment of localized prostate cancer decreases mortality: First analysis of the first prospective and randomized study on prostate cancer screening
Abstract
It is believed that the only possibility of an important decrease in death from prostate cancer is the diagnosis and treatment of the disease at a localized stage. As a response to this need, the present study was started in a population of 46 193 men aged 45–80 years registered in the electoral roll of Quebec City and its metropolitan area. These men were randomized between screening and no screening in a study aimed at assessing the impact of prostate cancer screening on cancer-specific death. At first visit, screening included measurement of serum prostatic specific antigen (PSA) using 3.0 ng/ml as the upper limit of normal, and digital rectal examination. Transrectal ultrasonography of the prostate was performed only if PSA and/or digital rectal examination were abnormal. At follow-up visits, only PSA measured annually was used as a screening test during the recent years. The prostate cancer death rates during the 8-year period of this study were 48.7/100 000 and 15/100 000 man-years in the unscreened and screened groups, respectively, for a 3.25 odds ratio in favor of screening and early treatment (p < 0.01), or a 69% decrease in the incidence of prostate cancer death. The present data show that screening is an efficient, reliable and acceptable technique for detecting localized prostate cancer in the general population. Coupled with treatment of localized disease, the present approach demonstrates, for the first time, that early diagnosis and treatment result in a dramatic decrease in death from prostate cancer. If the current trend continues, the data suggest that, among the male population in the United States, the present approach could save 2.0 million lives of the 3.0 million men expected to die from prostate cancer.