Screening decreases prostate cancer death: First analysis of the 1988 Quebec Prospective Randomized Controlled Trial

• Published in: The Prostate Vol. 38; no. 2; pp. 83 - 91
• Main Authors: Labrie, Fernand, Candas, Bernard, Dupont, André, Cusan, Lionel, Gomez, Jose-Luis, Suburu, Raul E., Diamond, Pierre, Lévesque, Jacques, Belanger, Alain
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 01-02-1999; Wiley-Liss
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cohort Studies; combined androgen blockade; early treatment of prostate cancer; Humans; Incidence; Male; Mass Screening - economics; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Palpation; Prospective Studies; Prostate - diagnostic imaging; prostate cancer screening; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - economics; Prostatic Neoplasms - mortality; PSA; Quebec - epidemiology; Rectum; Time Factors; transrectal ultrasonography; Tumors of the urinary system; Ultrasonography; Urinary tract. Prostate gland; Canada; North America; America; Quebec; Human; Adenocarcinoma; Urinary system disease; Prostate disease; Mortality; Male; Early stage; Tumoral marker; Malignant tumor; Medical screening; Prostate specific antigen; Randomization; Treatment; Follow up study; Adult; Male genital diseases; Prostate; Comparative study
• ISSN: 0270-4137; 1097-0045
• DOI: 10.1002/(SICI)1097-0045(19990201)38:2<83::AID-PROS1>3.0.CO;2-B

BACKGROUND
The 46,193 men aged 45 to 80 years registered in the electoral roll of Quebec City and its Metropolitan area were randomized in November 1988 between screening and no screening in a study aimed of assessing the impact of prostate cancer screening on cause‐specific death.
METHODS
At first visit, screening included measurement of serum prostatic specific antigen (PSA) using 3.0 ng/ml as upper limit of normal and a digital rectal examination (DRE). Transrectal echography of the prostate (TRUS) was performed only if PSA and/or DRE was abnormal and biopsy was then done, only if PSA was above the predicted PSA value. At follow‐up visits, PSA alone was used as prescreening.
RESULTS
137 deaths due to prostate cancer occurred between 1989 and 1996, inclusively, in the 38,056 unscreened men while only 5 deaths were observed among the 8,137 screened individuals. The prostate cancer death rates during the eight‐year period were 48.7 and 15 per 100,000 man‐years in the unscreened and screened groups, respectively, for a 3.25 odds ratio in favor of screening and early treatment (P < 0.01).
CONCLUSIONS
If PSA screening is started at the age of 50 years (or 45 years in the higher risk population), annual or biannual PSA alone is highly efficient to identify the men who are at high risk of having prostate cancer. Coupled with treatment of localized disease, this approach demonstrates, for the first time, that early diagnosis and treatment permits a dramatic decrease in deaths from prostate cancer. Prostate 38:83–91, 1999. © 1999 Wiley‐Liss, Inc.