(UroToday.com) The aim of prostate cancer screening is to diagnose the patient early, which increases their chance of cure and subsequently reduces suffering and dying from the disease. In the European Randomized study of Screening for Prostate Cancer (ERSPC) this concept was tested and confirmed, with many high-impact publications over the past two decades.1-3 At the 2020 AUA Virtual Annual Meeting Monique Roobol, MD, PhD, and colleagues provided an overview of what it takes to reduce the burden of prostate cancer using detailed long-term data of the ERSPC Rotterdam arm.
In 1993-1999, ERSPC Rotterdam randomized 34,832 men, aged 55-69 years to a screening or control arm. PSA based screening was done with a 4-year interval up to 74 years of age: for example, 2-5 visits were possible. All men randomized were followed through linkages with the cancer registry, statistics Netherlands and if applicable semi-annual chart review. The authors assessed the effect on metastatic disease, prostate cancer mortality and number of diagnoses, tumor characteristics, type of initial treatment, progression, secondary treatment and side effects:
In the ERSPC Rotterdam arm, there were 17,442 men and 17,390 men randomized to the screening and control arm, respectively. After a median follow-up of 19 years (IQR 13-21), the excess incidence in the screening arm was 58 cases per 1000 men, with the majority T1 prostate cancer (58 in the screening arm and 49 in the control arm per 100 prostate cancer cases detected). The opposite was seen for T3/T4 prostate cancer (11 in the screening arm and 23 in the control arm per 100 prostate cancer cases detected). Gleason score 6 prostate cancer represents 66 per 100 cases detected in the screening arm and 43 cases per 100 cases detected in the control arm. Initial treatment reflects these differences with more hormonal therapy and less surgery in the control arm. Progression was reported in 28% of cases in the screening arm, and 36% of cases in the control arm. Secondary treatment data show that 35-39% of men leave active surveillance, and hormonal therapy as secondary treatment was administered mainly after radiotherapy in 10 cases per 100 prostate cancer cases in the screening arm and 17 cases in the control arm. Overall, 18 cases per 100 prostate cancer cases in the screening arm, and 45 cases in the control arm received hormonal therapy. Incontinence and impotence was reported in up to 50% of men undergoing radical prostatectomy. Finally, metastatic disease and mortality reductions were 37% and 24%, respectively, in favor of the screening arm.
Dr. Roobol concluded her presentation of long-term follow-up of the ERSPC trial with the following take-home messages:
- Long term data show screening results in the excess incidence of low-risk prostate cancer and reduction in metastatic disease and prostate cancer mortality
- Reduction of hormonal therapy in the screening arm is considerable
- Active surveillance seems not to be able to counteract the excess incidence of low-risk prostate cancer, and long-term side effects of surgery are frequently reported
- Screening reduces suffering from advanced disease and related treatment but avoiding overdiagnosis and overtreatment remains crucial
Presented by: Monique Roobol, MD, PhD, Professor of Decision Making in Urology, Head of the Scientific Research Office, Department of Urology, Erasmus University Medical Center Rotterdam, Netherlands
Written by: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, August, Georgia, USA, Twitter: @zklaassen_md, at the 2020 American Urological Association (AUA) Annual Meeting, Virtual Experience #AUA20, June 27- 28, 2020
References:
- Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009;360(13):1320-1328.
- Hugosson J, Roobol MJ, Mansson M, et al. A 16-yr Follow-up of the European Randomised Study of Screening for Prostate Cancer. Eur Urol 2019 Jul;76(1):43-51.
- Schroder FH, Hugosson J, Roobol M, et al. Screening and Prostate Cancer Mortality: Results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 Years of Follow-Up. Lancet 2014 Dec 6;384(9959):2027-2035.