Effectiveness of prostate cancer screening in reducing adult mortality: a quasi-systematic review

Page 1

LlewellynS VitaccessLtd,Oxford,UK

Background&Objectives

Prostatecancer(PCa)isthemostfrequentlydiagnosedmalecancerandtheleadingcause ofcancerdeathindevelopedcountries¹.ThemajorityofmaleswithPCahaveno symptomsandtheirtumorsaredetectedbyroutinetesting².Forthosewhodoexperience symptoms,theseincludelowerurinarytractissues(e.g.,nocturiaandpoorurinarystream), erectiledysfunction,andvisiblehaematuria³

Theestimated5-yearsurvivalrateformostmaleswithlocalorregionalPCaisnearly100%, whileforthosewithmetastaticPCathisdropsto31%⁴.ObservedreductionsinPCa mortalityrateshavebeenlinkedtoearlierdiagnosisduetoscreeningaccess,plus treatmentimprovements.ThisreviewaimedtoinvestigatetheeffectivenessofPCa screeninginreducingmortalityratesamongadults.

Methods

Aquasi-systematicreviewofPCascreeningstudieswasconductedusingtheCochrane CentralRegisterofControlledTrials(CENTRAL)andPubMed®electronicdatabases.

Recordswereabstract-screenedagainsttheeligibilitycriteria:Englishlanguage,fulltext articleavailable,adult-focused,PCascreeningincluded,andwithmortalityasanoutcome.

Results

Atotalof132recordswereinitiallyscreenedand46full-textarticleswereeligibility assessed;ofthese,sevenmetthecriteria,includingsixrandomizedcontrolledtrials(RCTs) comparingmassPCascreeningtonoscreening,andonecohortstudyinvestigatingthe impactsofperiodicPCaexaminations.PCa-specificmortalitywastheprimaryoutcome reported.AdditionaloutcomesincludedPCaincidenceandoverallmortality(OM).PCaspecificmortalityandOMarepresentedhere.

PCa-specificmortality

PCa-specificmortalityasreportedintheincludedstudiesisoutlinedin Table1

Wherereportedasperson-years(n=4studies),PCa-specificmortalityratesrangedfrom 0.2–0.6per1,000person-yearsamonginterventiongroups,and0.3–0.7per1,000personyearsamongcomparisongroups.Wherereportedasapercentage(n=3studies),rates rangedfrom1–35%amonginterventiongroups,and3–45%amongcomparisongroups.

Wherestatisticalsignificancewasreported(n=4studies),differencesinPCa-specific mortalityrates–eitherrateratio(RR)orriskratio–betweeninterventionandcomparison groupswereonlystatisticallysignificant(p<0.003)intwostudies(Hugossonetal.,2019and Labrieetal.,2004).Forbothstudies,maleswhodidnotreceivePCascreeningwere statisticallysignificantlymorelikelytodiefromPCathanmaleswhodidreceivescreening.

Table1: PCa-specificmortality

Overallmortality

OMasreportedintheincludedstudiesisoutlinedin Table2.OMwasreportedinfourofthe includedstudies.

Wherereportedasapercentage(n=3studies),ratesrangedfrom6–81%among interventiongroupsand59–86%amongcomparisongroups.Wherestatisticalsignificance wasreported(Martinetal.,2018only),thedifferenceinOMbetweentheinterventionand comparisongroupswasnotstatisticallysignificant.Thisindicatesthatwhilemalesinthis studyweremorelikelytodieiftheydidnotreceivePCascreening(comparedtothosewho did),nostatisticallysignificantbenefitofPCascreeningonOMwasfound.

Discussion&Conclusions

FindingssuggestthatmalesscreenedforPCamaybelesslikelytodieduringagiven follow-upperiod,thusindicatingeffectivenessofscreeninginreducingadultmortality. ThiscouldbeusedtorecommendwidespreadrolloutofPCascreening.Thereare, however,implications,includingnegativelyimpactingindividualswhoreceive screeningandimposingasubstantialeconomicburden.

Astrengthofthisreview,overarecentcomparableCochranereviewofPCascreening effectiveness²,isthatconclusionsaredrawnfromaricher(i.e.,widerandmorerecent) poolofdata.

Abbreviations:CI=Confidenceinterval;N/A=Notapplicable;N/R=Notreported;N/S=Notstatisticallysignificant;RR=Rateratio aReportedas100,000person-years bReportedas10,000person-years

Table2: Overallmortality

Abbreviations:CI=Confidenceinterval;N/A=Notapplicable;N/R=Notreported;RR=Rateratio

Alimitationofthisreviewisthatitusedthematicanalysisasameansofsynthesizing theevidence,whichisconsideredmoresubjectivethantheuseofameta-analysis⁵ However,itwasnotpossibletoconductameta-analysisduetoclinicalheterogeneity ofthestudiesincluded.

AsnoclearstatisticallysignificantbenefitofscreeningovernoscreeningforPCaspecificmortalityorOMwasestablished,conductingareviewcomprisingadditional yearsoffollow-updatafromPCastudiesisrecommended.

References

1BrayFetal. CACancerJClin.2018;68(6):394-424.

2IlicDetal. CochraneDatabaseSystRev.2013;2013(1):CD004720.

3MerrielSWD,FunstonG,HamiltonW. AdvTher.2018;35(9):1285-1294.

4Cancer.Net. ProstateCancer:Statistics.2020.Availableat:https://www.cancer.net/cancer-types/prostate-cancer/ statistics.Accessed:Apr2023.

5CRD. CRD’sguidanceforundertakingreviewsinhealthcare.2009.York:YorkPublishingServices.

Finalstudiesincludedinreview

HugossonJetal. EurUrol.2019;76(1):43-51.

LabrieFetal. Prostate.1999;38(2):83-91.

LundgrenPetal. JUrol.2018;200(1):82-88.

MartinRMetal. JAMA.2018;319(9):883-895.

MettlinCJetal. Cancer.1997;80(9):1814-1817.

PinskyPFetal. BJUInt.2019;123(5):854-860.

SandblomGetal. BMJ.2011;342:d1539.

Study Follow-upperiod PCa-specificmortalityrate Intervention group Comparisongroup Differencebetween groups Hugossonetal. (2019) 16years(bothgroups) 0.53per1,000 person-years 0.66per1,000 person-years RR=0.80,95%CI0.720.89,p<0.001 Labrieetal. (1999) 7.93years(median,both groups) 0.20per1,000 person-years� 0.52per1,000 person-years� Riskratio=0.39,95%CI 0.21-0.72,p=0.003 Lundgrenetal. (2018) 16.1years(mean, interventiongroup) 15.4years(mean, comparisongroup) 3.3% 3.4% RR=0.97,95%CI0.711.23,p=N/R Martinetal. (2018) 10years(median,both groups) 0.30per1,000 person-years 0.31per1,000 person-years RR=0.96,95%CI0.851.08,p=N/S Mettlinetal. (1997) 4.6years(average) 2(0.86%) N/A N/A Pinskyetal. (2019) 16.9years(median, interventiongroup) 16.7years(median, comparisongroup) 0.55per1,000 person-years� 0.59per1,000 person-years� RR=0.93,95%CI0.811.08,p=N/S Sandblometal. (2011) 6.3years(median, interventiongroup) Comparisongroup follow-upperiodnot reported 30/85(35.29%) 130/292(44.52%) Riskratio=1.16,95%CI 0.78-1.73,p=N/R
Effectivenessofprostatecancerscreeninginreducingadultmortality:aquasi-systematicreview
EPH132
Study Follow-upperiod Overallmortalityrate Intervention group Comparisongroup Differencebetween groups Lundgrenetal. (2018) 16.1years(mean, interventiongroup) 15.4years(mean, comparisongroup) 54.6% 58.6% RR=0.92,95%CI0.860.98,p=N/R Martinetal. (2018) 10years(median,both groups) 13.74per1,000 person-years 13.51per1,000 person-years RR=0.99,95%CI0.941.03,p=N/S Mettlinetal. (1997) 4.6years(average) 13(5.58%) N/A N/A Sandblometal. (2011) 6.3years(median, interventiongroup) Comparisongroup follow-upperiodnot reported 69/85(81.18%) 252/292(86.30%) N/R

Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.