All-Cause Mortality Risk in National Prostate Cancer Cohort: An Impact of Population-Based Prostate Cancer Screening

Abstract

The aim of this study is to evaluate all-cause mortality risk differences before and during prostate cancer screening, with a profound focus on the differences between screened and not-screened patient groups. Prostate cancer cases diagnosed between 1998 and 2016 were identified from the population-based Lithuanian Cancer Registry and linked with screening status in the National Health Insurance Fund database. The analysis was stratified by a period of diagnosis and screening status. Standardized mortality ratios (SMRs) were used to assess all-cause and cause-specific mortality risk. The SMRs were calculated by dividing the observed number of deaths among prostate cancer patients by the expected number of deaths from the general population. All-cause SMR (1.45 (95% CI 1.42–1.48)) in the pre-screening period was higher compared to the screening period (SMR = 1.17 (95% CI 1.15–1.19)). An increased all-cause mortality risk among prostate cancer patients was observed in the not-screened patient population (SMR = 1.76 (95% CI 1.71–1.82)), while all-cause mortality risk in the screened patient population was similar to the general population (SMR = 1.00 (95% CI 0.97–1.02)). Screened patients with localized stage of disease had lower all-cause mortality risk than the general population (SMR = 0.72 (95% CI 0.70–0.75)). In conclusion, men with prostate cancer in Lithuania had excess all-cause mortality risk compared to the general population. The all-cause mortality risk among screened patients was not higher than expected.

Adherence to a risk‐adapted screening strategy for prostate cancer: First results of the PROBASE trial

“…Overall, about 80% of men in the immediate screening arm (ie, starting PSA testing at age 45) returned for scheduled screening rounds during their first 5 or more years in the study, compared with only 74% for men whose first PSA testing was deferred until the age of 50. In absolute, these adherence rates in both study arms exceed by far the usual participation rates observed in other European prostate screening trials 19,20 and long‐established cancer screening programs in Germany, such as routine screening for breast cancer (52% 21 ) and colorectal cancer (11‐26% 22 ), although it should be acknowledged that those men who agreed to participate in PROBASE (<12% from all invited) might have represented men who have higher interest in screening in general. Regarding the lower participation in the deferred screening arm, we speculate that dissatisfaction with the lack of an immediate screening offer may have motivated a proportion of men to independently seek PSA testing through medical practices, abandoning further participation in the PROBASE trial.…”

Prostate-Specific Antigen and Testosterone Levels as Biochemical Indicators of Cognitive Function in Prostate Cancer Survivors and the Role of Diabetes

“…Despite considerable progress in the detection and treatment of PC, it remains the fifth leading cause of death worldwide, with approximately 375,000 deaths per year. PC patients die more often from any cause than the general population [2,3]. Advances in medicine, particularly in screening and in the design of effective treatments, have led to an increase in the population of patients with PC, which requires specific care tailored to each problem.…”