Skip to main content

Advertisement

SpringerLink
Log in

Prostate-Specific Antigen Screening and Mortality from Prostate Cancer

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

There is no available evidence from randomized trials that early detection of prostate cancer improves health outcomes, but the prostate-specific antigen (PSA) test is commonly used to screen men for prostate cancer.

Objective

The objective of the study is to see if screening with PSA decreases mortality from prostate cancer.

Design, setting, and participants

This is a case-control study using one-to-one matching on race, age, and time of availability of exposure to PSA screening. Decedents, 380, from New Jersey Vital Statistics 1997 to 2000 inclusive, 55–79 years of age at diagnosis were matched to living controls without metastatic prostate cancer. Medical records were obtained from all providers, and we abstracted information about PSA tests from 1989 to the time of diagnosis in each index case.

Measurements

Measurements consist of a comparison of screening (yes, no) between cases and controls. Measure of association was the odds ratio.

Results

Eligible cases were diagnosed each year from 1989 to 1999 with the median year being 1993. PSA screening was evident in 23.2–29.2% of cases and 21.8–26.1% of controls depending on the screening criteria. The unadjusted, matched odds ratio for dying of prostate cancer if ever screened was 1.09 (95% CI 0.76 to 1.60) for the most restrictive criteria and 1.19 (95% CI, 0.85 to 1.66) for the least restrictive. Adjustment for comorbidity and education level made no significant differences in these values. There were no significant interactions by age or race.

Conclusions

PSA screening using an ever/never tabulation for tests from 1989 until 2000 did not protect New Jersey men from prostate cancer mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2001.

  2. US Task Force on Prevention. Screening for prostate cancer: recommendation and rationale. Ann of Intern Med. 2002;137:915–16.

    Google Scholar 

  3. Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer, 2006. CA Cancer J Clin. 2006;56:11–25.

    Article  PubMed  Google Scholar 

  4. Sox HC, Mulrow C. An editorial update: should benefits of radical prostatectomy affect the decision to screen for early prostate cancer? Ann Intern Med. 2005;143:232–3.

    PubMed  Google Scholar 

  5. Gann PH, Hennekens CH, Stampfer MJ. A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer. JAMA. 1995;273:289–94.

    Article  PubMed  CAS  Google Scholar 

  6. Jacobsen SJ, Bergstralh EJ, Guess HA, et al. Predictive properties of serum prostate-specific antigen testing in a community-based setting. Arch Intern Med. 1996;156:2462–8.

    Article  PubMed  CAS  Google Scholar 

  7. van der Cruijsen-Koeter IW, Vis AN, Roobol MJ, et al. Comparison of screen detected and clinically diagnosed prostate cancer in the European randomized study of screening for prostate cancer, section Rotterdam. J Urol. 2005;174:121–5.

    Article  PubMed  Google Scholar 

  8. Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < = 4.0 ng per milliliter. N Engl J Med. 2004;350:2239–46.

    Article  PubMed  CAS  Google Scholar 

  9. Bill-Axelson A, Holmberg L, Ruutu M, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med. 2005;352:1977–84.

    Article  PubMed  CAS  Google Scholar 

  10. Holmberg L, Bill-Axelson A, Helgesen F, et al. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med. 2002;347:781–9.

    Article  PubMed  Google Scholar 

  11. Concato J, Wells CK, Horwitz RI, et al. The effectiveness of screening for prostate cancer: a nested case-control study. Arch Intern Med. 2006;166:38–43.

    Article  PubMed  Google Scholar 

  12. Kopec JA, Goel V, Bunting PS, et al. Screening with prostate-specific antigen and metastatic prostate cancer risk: a population based case-control study. J Urol. 2005;174:495–9.

    Article  PubMed  Google Scholar 

  13. Weinmann S, Richert-Boe K, Glass AG, Weiss NS. Prostate cancer screening and mortality: a case-control study. Cancer Causes Control. 2004;15:133–8.

    Article  PubMed  Google Scholar 

  14. New Jersey Administrative Code (N.J.A.C. 8:57A-1.1 et seq.).

  15. Waksberg J. Sampling methods for random digit dialing. J Am Statistical Association. 1978;73:40–6.

    Article  Google Scholar 

  16. Schlesselman JJ. Analysis of Case-Control Studies: Design, Conduct, Analysis. New York: Oxford University Press; 1982.

    Google Scholar 

  17. Selby JV, Friedman GD, Quesenberry CP Jr., Weiss NS. Effect of fecal occult blood testing on mortality from colorectal cancer: a case-control study. Ann Intern Med. 1993;118:1–6.

    PubMed  CAS  Google Scholar 

  18. Selby JV, Friedman GD, Quesenberry CP Jr., Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326:653–7.

    Article  PubMed  CAS  Google Scholar 

  19. Muller AD, Sonnenberg A. Protection by endoscopy against death from colorectal cancer. A case-control study among veterans. Arch Intern Med. 1995;155:1741–8.

    Article  PubMed  CAS  Google Scholar 

  20. Clarke EA, Anderson TW. Does screening by “Pap” smears help prevent cervical cancer? A case-control study. Lancet. 1979;2:1–4.

    Article  PubMed  CAS  Google Scholar 

  21. van der Graaf Y, Zielhuis GA, Peer PG, Vooijs PG. The effectiveness of cervical screening: a population-based case-control study. J Clin Epidemiol. 1988;41121–6.

    Article  PubMed  Google Scholar 

  22. Demissie K, Mills OF, Rhoads GG. Empirical comparison of the results of randomized controlled trials and case-control studies in evaluating the effectiveness of screening mammography. J Clin Epidemiol. 1998;51:81–91.

    Article  PubMed  CAS  Google Scholar 

  23. Albertsen PC, Hanley JA, Fine J. 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA. 2005;293:2095–2101.

    Article  PubMed  CAS  Google Scholar 

  24. Gohagan JK, Prorok PC, Hayes RB, Kramer BS. The Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial of the National Cancer Institute: history, organization, and status. Control Clin Trials. 2000;21:251S.

    Article  PubMed  CAS  Google Scholar 

  25. de Koning HJ, Auvinen A, Berenguer Sanchez A, et al. Large-scale randomized prostate cancer screening trials: program performances in the European Randomized Screening for Prostate Cancer trial and the Prostate, Lung, Colorectal and Ovary cancer trial. Int J Cancer. 2002;97:237–44.

    Article  PubMed  CAS  Google Scholar 

  26. Frankel S, Smith GD, Donovan J, Neal D. Screening for prostate cancer. Lancet. 2003;361:1122–8.

    Article  PubMed  Google Scholar 

  27. Ransohoff DF, McNaughton Collins M, Fowler FJ. Why is prostate cancer screening so common when the evidence is so uncertain? A system without negative feedback. Am J Med. 2002;113:663–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Betsy A. Kohler, MPH, CTR, Director of Cancer Epidemiology Services, NJDHSS for help with obtaining registry records; Eddy A. Bresnitz, MD, MS, Deputy Commissioner/State Epidemiologist, NJDHSS for facilitating the cooperation of physicians; Janet B. Schoenberg, MPH, MPhil, for help with the initial planning of the study; Antonio M. Savillo, MD for communicating with the hospital tumor registrars; and Orlando Mills, MD, MPH for his writing of the grant in support of the study and for initial pilot work. Stephen Marcella, George Rhoads, and Jeffrey Carson received financial support from the National Cancer Institute Grant: NCI-RO1 CA71734-01A1.

Conflict of Interest

None of the authors have any conflict of interest to declare. The funding agency did not have a role in any aspect of the study including data collection, analysis, preparation of the manuscript, or the decision to publish.

Author information

Authors and Affiliations

  1. Department of Epidemiology, UMDNJ-School of Public Health, Piscataway, NJ, USA

    Stephen W. Marcella MD, MPH, George G. Rhoads MD, MPH & Frances Merlino RN

  2. Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Stephen W. Marcella MD, MPH & George G. Rhoads MD, MPH

  3. New Jersey Department of Health and Senior Services, Trenton, NJ, USA

    Homer Wilcox MS

  4. Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Jeffrey L. Carson MD

Authors
  1. Stephen W. Marcella MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George G. Rhoads MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeffrey L. Carson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Frances Merlino RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Homer Wilcox MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephen W. Marcella MD, MPH.

Additional information

This study was presented at a poster session at the Annual Meeting on Cancer Prevention of the American Association for Cancer Research, November 14th, 2006 in Boston, USA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marcella, S.W., Rhoads, G.G., Carson, J.L. et al. Prostate-Specific Antigen Screening and Mortality from Prostate Cancer. J GEN INTERN MED 23, 248–253 (2008). https://doi.org/10.1007/s11606-007-0479-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-007-0479-7

Key words

Search

Navigation