Comparing PSA screening patterns and their role as predictor of prostate cancer incidence and mortality: A system wide analysis of a contemporary North American cohort

Document Type

Conference Proceeding

Publication Date

3-1-2024

Publication Title

Eur Urol

Abstract

Introduction & Objectives: Prostate-specific antigen (PSA) screening, despite the risks of over-diagnosis and over-treatment, remains a pivotal tool for early prostate cancer (PCa) detection. International guidelines rely on evidence from three major randomized clinical trials: the European Randomized Study of Screening for Prostate Cancer (ERSPC), the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO), and the Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP). Our study aims to examine the percentage of patients in real-world practice who get PSA screening, as defined by each of the aforementioned trials. Moreover, we seek to evaluate if the different PSA screening patterns have a different impact on PCa incidence and mortality (PCSM). Materials & Methods: Our institutional database was queried to identify men aged 55 to 69 who received at least one PSA test and did not develop PCa or died within 6 years of the initial test. A total of 54,131 patients met our selection criteria. We categorized patients into three distinct PSA screening patterns based on testing frequency (PLCO: 1 PSA test per year for 6 years; ERSPC: 2 or 3 PSA tests over 6 years; CAP: 1 PSA test over 6 years). Our primary outcome measure was PCa incidence, with PCSM as the secondary outcome. Cumulative incidence curves were used to depict PCa diagnosis and PCSM rates. Multivariable Fine-Gray regression assessed the impact of the different Screening patterns on PCa incidence and PCSM, after adjusting for confounding factors. Results: Within our cohort, the median (IQR) age at the first PSA test was 61 (58-65), and the median (IQR) initial PSA level was 1 (0.5-2) ng/ml. The most prevalent PSA screening pattern was ERSPC, including 26,103 patients (48.2%), followed by the CAP with 22,991 patients (42.5%), and the PLCO with only 5,037 patients (9.3%). The median (IQR) follow-up time was 6.4 (2.9-11.3) years. At 10-year, PCa incidence rates was 16.5% vs 5.3% vs 1.6% for patients with PLCO vs ERSPC vs CAP screening pattern, respectively (p<0.001). The 10-year PCSM rates for the same groups were 1.5% vs 0.7% vs 0.7%, respectively (p=0.016). On multivariable analysis, PLCO Screening and ERSPC Screening patterns were associated with, respectively, 8.18-fold (95% CI: 7.23-9.27) and 2.79-fold (95% CI: 2.49-3.13) higher risks of PCa diagnosis, compared to those with a CAP Screening pattern (both p<0.001). Conversley, screening pattern was not an independent predictor of PCSM on multivariable analysis (all p>0.05). Conclusions: Our study is the first to examine screening patterns in a real world setting and to assess the predictive potential of distinct screening patterns on cancer control outcomes. Notably, more intense screening patterns (PLCO and ERSPC) seemed to result in 3-8 fold higher risk of being diagnosed with PCa without resulting in more favorable PCSM.

Volume

85

First Page

S434

Last Page

S434

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