Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality: The CAP Randomized Clinical Trial
Richard M. Martin,Richard M. Martin,Jenny L Donovan,Jenny L Donovan,Emma L Turner,Chris Metcalfe,Grace J. Young,Eleanor I Walsh,J. Athene Lane,Sian Noble,Steven E. Oliver,Simon Evans,Jonathan A C Sterne,Jonathan A C Sterne,Peter Holding,Yoav Ben-Shlomo,Yoav Ben-Shlomo,Peter Brindle,Naomi J Williams,Elizabeth M Hill,Siaw Yein Ng,Jessica Toole,Marta Tazewell,Laura J Hughes,Charlotte F Davies,Joanna Thorn,Elizabeth Down,George Davey Smith,David E. Neal,David E. Neal,Freddie C. Hamdy +30 more
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TLDR
There was no significant difference in prostate cancer mortality after a median follow-up of 10 years but the detection of low-risk prostate cancer cases increased and the findings do not support single PSA testing for population-based screening.Abstract:
Importance Prostate cancer screening remains controversial because potential mortality or quality-of-life benefits may be outweighed by harms from overdetection and overtreatment. Objective To evaluate the effect of a single prostate-specific antigen (PSA) screening intervention and standardized diagnostic pathway on prostate cancer–specific mortality. Design, Setting, and Participants The Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP) included 419 582 men aged 50 to 69 years and was conducted at 573 primary care practices across the United Kingdom. Randomization and recruitment of the practices occurred between 2001 and 2009; patient follow-up ended on March 31, 2016. Intervention An invitation to attend a PSA testing clinic and receive a single PSA test vs standard (unscreened) practice. Main Outcomes and Measures Primary outcome: prostate cancer–specific mortality at a median follow-up of 10 years. Prespecified secondary outcomes: diagnostic cancer stage and Gleason grade (range, 2-10; higher scores indicate a poorer prognosis) of prostate cancers identified, all-cause mortality, and an instrumental variable analysis estimating the causal effect of attending the PSA screening clinic. Results Among 415 357 randomized men (mean [SD] age, 59.0 [5.6] years), 189 386 in the intervention group and 219 439 in the control group were included in the analysis (n = 408 825; 98%). In the intervention group, 75 707 (40%) attended the PSA testing clinic and 67 313 (36%) underwent PSA testing. Of 64 436 with a valid PSA test result, 6857 (11%) had a PSA level between 3 ng/mL and 19.9 ng/mL, of whom 5850 (85%) had a prostate biopsy. After a median follow-up of 10 years, 549 (0.30 per 1000 person-years) died of prostate cancer in the intervention group vs 647 (0.31 per 1000 person-years) in the control group (rate difference, −0.013 per 1000 person-years [95% CI, −0.047 to 0.022]; rate ratio [RR], 0.96 [95% CI, 0.85 to 1.08]; P = .50). The number diagnosed with prostate cancer was higher in the intervention group (n = 8054; 4.3%) than in the control group (n = 7853; 3.6%) (RR, 1.19 [95% CI, 1.14 to 1.25]; P P P = .49). In the instrumental variable analysis for prostate cancer mortality, the adherence-adjusted causal RR was 0.93 (95% CI, 0.67 to 1.29; P = .66). Conclusions and Relevance Among practices randomized to a single PSA screening intervention vs standard practice without screening, there was no significant difference in prostate cancer mortality after a median follow-up of 10 years but the detection of low-risk prostate cancer cases increased. Although longer-term follow-up is under way, the findings do not support single PSA testing for population-based screening. Trial Registration ISRCTN Identifier:ISRCTN92187251read more
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EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer—2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent
Nicolas Mottet,Roderick C.N. van den Bergh,Erik Briers,Thomas Van den Broeck,Marcus G. Cumberbatch,Maria De Santis,Maria De Santis,Stefano Fanti,Nicola Fossati,Giorgio Gandaglia,Silke Gillessen,Silke Gillessen,N. Grivas,Jeremy Grummet,Ann Henry,Theodorus H. van der Kwast,Thomas B. Lam,Thomas B. Lam,Michael Lardas,Matthew Liew,Malcolm David Mason,Lisa Moris,Daniela E. Oprea-Lager,Henk G. van der Poel,Olivier Rouvière,Ivo G. Schoots,Ivo G. Schoots,Derya Tilki,Thomas Wiegel,Peter-Paul M. Willemse,Philip Cornford +30 more
TL;DR: The 2020 EAU-EANM-ESTRO-ESUR-SIOG guidelines on PCa guidelines summarise the most recent findings and advice for their use in clinical practice and include a strong recommendation to consider moderate hypofractionation in intermediate-risk patients.
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A view on drug resistance in cancer
TL;DR: A reductionist approach is taken to define and separate the key determinants of drug resistance, which include tumour burden and growth kinetics; tumour heterogeneity; physical barriers; the immune system and the microenvironment; undruggable cancer drivers; and the many consequences of applying therapeutic pressures.
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Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement.
David C Grossman,Susan J. Curry,Douglas K Owens,Douglas K Owens,Kirsten Bibbins-Domingo,Aaron B. Caughey,Karina W. Davidson,Chyke A. Doubeni,Mark H. Ebell,John W. Epling,Alex R. Kemper,Alex H. Krist,Martha Y. Kubik,C. Seth Landefeld,Carol M. Mangione,Michael Silverstein,Melissa A. Simon,Albert L. Siu,Albert L. Siu,Chien-Wen Tseng +19 more
TL;DR: The USPSTF concludes with moderate certainty that the net benefit of PSA-based screening for prostate cancer in men aged 55 to 69 years is small for some men.
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Recent Global Patterns in Prostate Cancer Incidence and Mortality Rates.
TL;DR: Recent trends in prostate cancer incidence and mortality rates have been on the decline or have stabilized recently in many countries, with decreases more pronounced in high-income countries.
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Prostate-Specific Antigen-Based Screening for Prostate Cancer: Evidence Report and Systematic Review for the US Preventive Services Task Force.
TL;DR: PSA screening may reduce prostate cancer mortality risk but is associated with false-positive screening results, biopsy complications, and overdiagnosis, and active treatments for screen-detected prostate cancer have unclear effects on long-term survival but are associated with sexual and urinary difficulties.
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