Follow-up of Prostatectomy versus Observation for Early Prostate Cancer

Wilt, Timothy J; Jones, Karen; Barry, Michael J.; Andriole, Gerald L.; Culkin, Daniel J.; Wheeler, Thomas M.; Aronson, William J.; Brawer, Michael K.

doi:10.1056/nejmoa1615869

Cited by 501 publications

(436 citation statements)

References 30 publications

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“…5 However, surgery and radiotherapy reduced the rate of metastatic disease intermediate-risk disease may benefit from early intervention. 40 Nevertheless, there was no significant effect of the intervention on the pre-specified primary outcome of prostate cancer mortality at a median of 10-years' follow-up.…”

Section: Limitationsmentioning

confidence: 93%

Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality

Martin

Donovan

Turner

et al. 2018

JAMA

342

325

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms cancer was higher in the intervention (4.3%) group than control (3.6%) group, but there was no significant difference in prostate cancer mortality (intervention, 0.29% vs. control, 0.29%) after a median follow-up of 10-years. Meaning:The CAP single PSA-screen intervention detected more prostate cancer cases, but after a median of 10-years' follow-up has, thus far, had no significant effect on prostate cancer mortality. Conclusion and relevance:Among practices randomized to a low-intensity PSA screening intervention compared with standard practice, there was no significant difference in prostate cancer mortality after a 4 median 10-years follow up, but the detection of low-risk prostate cancers increased. Although longer-term follow-up is in progress, the current findings do not support single PSA-testing for population-based screening.

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Section: Limitationsmentioning

confidence: 93%

Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality

Martin

Donovan

Turner

et al. 2018

JAMA

342

325

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show abstract

“…There was only increased survival in the cases of more aggressive tumors. 14 Prostate biopsy indications have also changed over the years. After the Prostate Cancer Prevention Trial (PCPT) study showed cancer in at least 15% of patients with PSA < 4 ng/mL, prostate biopsy began to be recommended with lower PSA values of around 2.5 ng/mL, and this has contributed to the progressive finding of clinically insignificant tumors of lower biological aggressiveness.…”

Section: -11mentioning

confidence: 99%

PSA screening for prostate cancer

Sadi

2017

Rev. Assoc. Med. Bras.

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Screening of prostate cancer with prostate-specific antigen (PSA) is a highly controversial issue. One part of the controversy is due to the confusion between population screening and early diagnosis, another derives from problems related to the quality of existing screening studies, the results of radical curative treatment for low grade tumors and the complications resulting from treatments that affect the patient's quality of life.Our review aimed to critically analyze the current recommendations for PSA testing, based on new data provided by the re-evaluation of the ongoing studies and the updated USPSTF recommendation statement, and to propose a more rational and selective use of PSA compared with baseline values obtained at an approximate age of 40 to 50 years.

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“…29 It found no significant prostate cancer-specific mortality or overall survival benefit for radical surgery over active monitoring at 12 years, confirmed at 19.5 years follow-up. 30 PIVOT showed an absolute risk reduction of 5.5% (95% confidence interval [CI] -1.5, 12.4%; p = 0.06) for all-cause mortality (61.3% in patients treated with prostatectomy vs 66.8% in patients who had active monitoring) and an absolute risk reduction of 4% (95% CI -0.2%, 8.3%; p = 0.06) for prostate cancer-specific mortality (7.4% in patients treated with prostatectomy vs 11.4% in patients who had active monitoring). Although surgery reduced the need for treatment of progressive disease, there were increased treatment-related long-term complications such as urinary incontinence and erectile dysfunction.…”

Section: View From An Oncologist -By Ian Hainesmentioning

confidence: 99%