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Risk of Prostate Cancer-related Death Following a Low PSA Level in the PLCO Trial.

ABSTRACT: Longer-than-annual screening intervals have been suggested to improve the balance of benefits and harms in prostate cancer screening. Many researchers, societies, and guideline committees have suggested that screening intervals could depend on the prostate-specific antigen (PSA) result. We analyzed data from men (N = 33,897) ages 55-74 years with a baseline PSA test in the intervention arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial (United States, 1993-2001). We estimated 5- and 10-year risks of aggressive cancer (Gleason ?8 and/or stage III/IV) and 15-year risks of prostate cancer-related mortality for men with baseline PSA ? 0.5 ng/mL (N = 4,862), ?1 ng/mL (N = 15,110), and 1.01-2.5 ng/mL (N = 12,422). A total of 217 men died from prostate cancer through 15 years, although no men with PSA ? 1 ng/mL died from prostate cancer within 5 years [95% confidence interval (CI), 0.00%-0.03%]. The 5-year incidence of aggressive disease was low (0.08%; 95% CI, 0.03%-0.12%) for men with PSA ? 1 ng/mL, and higher for men with baseline PSA 1.01-2.5 ng/mL (0.51%; 95% CI, 0.38%-0.74%). No men aged ?65 years with PSA ? 0.5 ng/mL died from prostate cancer within 15 years (95% CI, 0.00%-0.32%), and their 10-year incidence of aggressive disease was low (0.25%; 95% CI, 0.00%-0.53%). Compared with white men, black men with PSA ? 1 ng/mL had higher 10-year rates of aggressive disease (1.6% vs. 0.4%; P < 0.01). Five-year screening intervals may be appropriate for the 45% of men with PSA ? 1 ng/mL. Men ages ?65 years with PSA ? 0.5 ng/mL could consider stopping screening. Substantial risk disparities suggest appropriate screening intervals could depend on race/ethnicity.

SUBMITTER: Landy R

PROVIDER: S-EPMC7339970 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Risk of Prostate Cancer-related Death Following a Low PSA Level in the PLCO Trial.

Landy Rebecca R Houghton Lauren C LC Berg Christine D CD Grubb Robert L RL Katki Hormuzd A HA Black Amanda A

Cancer prevention research (Philadelphia, Pa.) 20200129 4

Longer-than-annual screening intervals have been suggested to improve the balance of benefits and harms in prostate cancer screening. Many researchers, societies, and guideline committees have suggested that screening intervals could depend on the prostate-specific antigen (PSA) result. We analyzed data from men (<i>N</i> = 33,897) ages 55-74 years with a baseline PSA test in the intervention arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial (United States, 1993-2001). We ...[more]

PMID: 31996370

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Project description:BackgroundVitamin E compounds exhibit prostate cancer preventive properties experimentally, but serologic investigations of tocopherols, and randomized controlled trials of supplementation in particular, have been inconsistent. Many studies suggest protective effects among smokers and for aggressive prostate cancer, however.MethodsWe conducted a nested case-control study of serum ?-tocopherol and ?-tocopherol and prostate cancer risk in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, with 680 prostate cancer cases and 824 frequency-matched controls. Multivariate-adjusted, conditional logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CIs) for tocopherol quintiles.ResultsSerum ?-tocopherol and ?-tocopherol were inversely correlated (r?=?-0.24, p<0.0001). Higher serum ?-tocopherol was associated with significantly lower prostate cancer risk (OR for the highest vs. lowest quintile?=?0.63, 95% CI 0.44-0.92, p-trend 0.05). By contrast, risk was non-significantly elevated among men with higher ?-tocopherol concentrations (OR for the highest vs. lowest quintile?=?1.35, 95% CI 0.92-1.97, p-trend 0.41). The inverse association between prostate cancer and ?-tocopherol was restricted to current and recently former smokers, but was only slightly stronger for aggressive disease. By contrast, the increased risk for higher ?-tocopherol was more pronounced for less aggressive cancers.ConclusionsOur findings indicate higher ?-tocopherol status is associated with decreased risk of developing prostate cancer, particularly among smokers. Although two recent controlled trials did not substantiate an earlier finding of lower prostate cancer incidence and mortality in response to supplementation with a relatively low dose of ?-tocopherol, higher ?-tocopherol status may be beneficial with respect to prostate cancer risk among smokers. Determining what stage of prostate cancer development is impacted by vitamin E, the underlying mechanisms, and how smoking modifies the association, is needed for a more complete understanding of the vitamin E-prostate cancer relation.

Dataset Information

Risk of Prostate Cancer-related Death Following a Low PSA Level in the PLCO Trial.

Publications

Risk of Prostate Cancer-related Death Following a Low PSA Level in the PLCO Trial.

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