5-Year PCa-Specific Mortality Declined With Increased PSA Testing

From 1995 to 2011, prostate cancer deaths fell by 13.0% among Danish patients diagnosed with low-risk disease.
From 1995 to 2011, prostate cancer deaths fell by 13.0% among Danish patients diagnosed with low-risk disease.

In Denmark, fewer patients with lower risk, localized prostate cancer (PCa) during 2006-2011 died within 5 years of diagnosis compared with 1995–2000, a trend largely observed in patients who did not undergo radical prostatectomy (RP), researchers reported at the 2017 Genitourinary Cancers Symposium in Orlando, Florida. Increased use of PSA testing occurred in Denmark from 2000 onward.

The 5-year risk of prostate cancer-specific death significantly dropped from 14.3% in 1995–2000, the pre-PSA era, to 4.5% in 2001–2005, the low degree of PSA testing era, to just 1.3% in 2006–2011, the high degree of PSA testing era. Investigators based their retrospective analysis on national data from the Danish Prostate Cancer Registry, 1995 to 2011.

The study included 5660 patients diagnosed with T1-2 PCa (no lymph node involvement or metastases), Gleason score 6 or below, and PSA level less than 20 ng/mL.

“This decrease in 5-year PCa-mortality was mainly driven by a reduction in mortality for patients not undergoing curative surgery,” lead investigator Thomas Helgstrand, MD, of Copenhagen University Hospital, Rigshospitalet, told Renal & Urology News. For patients not undergoing radical prostatectomy, the 5-year risk of PCa death fell from 16.6% to 2.0% from 1995 to 2011. About 36% of patients underwent RP, and their 5-year PCa-specific mortality remained consistently below 1% over the study period.

Contemporary patients with lower-risk, localized PCa had better prognoses. In the group diagnosed 2006 -2011, only a small difference in 5-year PCa-specific mortality was observed between RP and no RP patients (0.45% vs 2.0%).

“Although there are important biases involved in this retrospective analysis, these data suggest that the reduction in 5-year PCa-specific mortality is caused primarily by earlier diagnosis. Increased use of PSA testing over the study period introduced lead time,” Dr Helgstrand stated. “A hypothesis generating message from this study is, that in contemporary cohorts of men with lower risk (PSA less than 20 ng/mL and Gleason score 6 or below), localized prostate cancer, the 5-year disease-specific mortality is low and do not differ significantly between men undergoing radical prostatectomy and patients that do not.”

Contemporary PCa patients were diagnosed at younger ages and had smaller tumor burden at diagnosis. From 1995 to 2011, the median age at diagnosis decreased from 72.2 to 66.0 years and the median PSA decreased from 16.2 to 8.6 ng/mL.

Information about treatments other than RP was lacking in this study, which is a limitation. Although the follow-up was short, when extrapolating results to 9 years of follow up, the small difference in PCa-specific mortality persisted between patients undergoing RP and not undergoing RP in the 2006-2011 group.

See more coverage from the Genitourinary Cancers Symposium.

Reference

1. Helgstrand TJ, Klemann N, Grønkaer Toft B, et al. Nationwide analysis: Changes in the natural history of low risk localized prostate cancer. Data presented in poster format at the 2017 Genitourinary Cancers Symposium in Orlando, Florida, February 16-18, 2017. Poster Session A (Board #A13). Abstract: 12. 

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