MP39-03 DECREASING SCREENING EFFICACY WITH INCREASING AGE: RESULTS FROM A POPULATION-BASED SCREENING TRIAL - SWISS ERSPC (AARAU)

You have accessJournal of UrologyProstate Cancer: Detection & Screening V1 Apr 2016MP39-03 DECREASING SCREENING EFFICACY WITH INCREASING AGE: RESULTS FROM A POPULATION-BASED SCREENING TRIAL - SWISS ERSPC (AARAU) Maciej Kwiatkowski, Lukas Prause, Stephen F Wyler, Tilmann Moeltgen, Andreas Huber, Rainer Grobholz, Lukas Manka, Alexander Müller, Marco Randazzo, and Franz Recker Maciej KwiatkowskiMaciej Kwiatkowski More articles by this author , Lukas PrauseLukas Prause More articles by this author , Stephen F WylerStephen F Wyler More articles by this author , Tilmann MoeltgenTilmann Moeltgen More articles by this author , Andreas HuberAndreas Huber More articles by this author , Rainer GrobholzRainer Grobholz More articles by this author , Lukas MankaLukas Manka More articles by this author , Alexander MüllerAlexander Müller More articles by this author , Marco RandazzoMarco Randazzo More articles by this author , and Franz ReckerFranz Recker More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.128AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is limited evidence for screening efficacy in older men. The aim of the current work was to investigate whether screening efficacy at age ≥ 67 was changed in men participating in the Swiss arm of the ERSPC. METHODS From 1998 to 2012, 4932 men aged 55 - 70 years were prospectively observed (ERSPC Aarau, Switzerland). PSA-screening was undertaken every 4 years with a value of ≥ 3.0 ng/ml as indication for prostate biopsy. Primary endpoint was PCa death or death from any causes. Aggressive PCa was defined as intermediate and high-risk PCa according to d′Amico classification. Screening was terminated at age 74. Men were allocated to group A (≤ 67years at randomization), undergoing more than 1 additional screening and group B (≥ 67 years at randomization), undergoing only 1 subsequent screening round. RESULTS Overall follow-up duration was 12.6 [11.01-13.83] years. Median age at study entrance was 59.8 [57.3-63.1] (group A) and 68.6 [IQR 67.8-69.4] (group B), respectively. A lower number of men belonging to group B were screened after 4 years as compared to those of group A (3634 [87.4%] (group A) vs. 640 (82.8%) (group B), OR 0.70, 95%CI 0.57-0.86; p=0.001). Crude PCa rate was significantly higher among men of group B as compared to group A (498 [12.0%] (A) vs. 112 [14.5%] (B); OR 1.25, 95%CI 0.99-1.55, p=0.05). Significantly more men from group B had clinical ≥ T3 stage (2 [0.4%] vs 3 [2.7%]; OR 6.78, 95%CI 1.12-41.1; p=0.02); the rate of aggressive PCa was comparable between both groups (201 [40.4%] (A) vs 44 [39.3%] (B); p=0.8). Men in group A received more surgery as primary treatment but less radiotherapy, expectant management and androgen deprivation therapy. There was a trend for higher rate of M1 among men of group B (p=0.09). Overall mortality was higher in men of group B as compared to men of group A. Likewise, PCa-specific death was higher in group B (all-cause mortality: 132 [17.3%] vs. 417 [10.2%], OR 1.87, 95% CI 1.51-2.32; p≤0.0001) (PCa-specific death 10 [1.3%] vs. 7 [0.2%], OR 7.77, 95% CI 2.95-20.5; p<0.0001). CONCLUSIONS PCa incidence, the rate of locally advanced disease and all-cause mortality in men of group B were significantly higher as compared to group A. However, this did not translate into a lower PCa-specific mortality. Therefore, screening efficacy seems to decrease with increasing age. Given the higher overall mortality in older men, the balance of harms and benefits may not justify beginning of screening at older age. Longer follow-up is needed to clarify when the ″steady state″ of organized screening program can be achieved. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e542 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Maciej Kwiatkowski More articles by this author Lukas Prause More articles by this author Stephen F Wyler More articles by this author Tilmann Moeltgen More articles by this author Andreas Huber More articles by this author Rainer Grobholz More articles by this author Lukas Manka More articles by this author Alexander Müller More articles by this author Marco Randazzo More articles by this author Franz Recker More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...