Effect of prostate-specific antigen screening on metastatic disease burden 10 years after diagnosis

To examine the effect of prostate-specific antigen screening on the development of metastatic disease after treatment relative to 1992, the year that prostate-specific antigen screening was recommended by the American Urological Association. Screening for cancer of the prostate (CaP) with prostate-specific antigen has been questioned because of its modest impact on survival in two randomized trials. Its impact on the metastatic disease burden in a population was not assessed. To account for lead-time bias, we compared the 10-year metastasis-free survival rate for the prescreening era group (PRE) to the 15-year metastases-free survival rate of the postscreening era group (POST).

From 1986 to 1996, a total of 1721 CaP patients were definitively treated at our institution. The cohort was divided into PRE (1986-1992; n = 575) and POST (1993-1996; n = 1146). PRE patients were censored at 10 years, and POST patients were censored at 15 years. The 10- and 15-year metastasis-free survival rate and the characteristics associated with the risk of developing metastatic disease were assessed.

Median follow up for all patients was 10 years (range 0.1-15 years), 9.6 years (range 0.1-10 years) for PRE, and 10.25 years (range 0.1-15 years) for POST. The 10-year PRE versus 15-year POST metastasis-free survival rate was 58% versus 65% for high-risk (P < .0001), 79% versus 86% for intermediate-risk (P < .0001), and 90% versus 96% (P = .0001) for low-risk patients. On multivariable analysis, screening era (P < .0001, hazard ratio = 4.2, 95% confidence interval = 3.1-5.7), T-stage, biopsy Gleason score, and post-treatment prostate-specific antigen testing frequency were significant for the development of metastatic disease.

The implementation of prostate-specific antigen screening in this population is associated with a decrease in metastatic disease.