Update of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial
The prostate portion of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial began in the early 1990s to assess the ability of annual PSA and DRE to reduce prostate cancer specific mortality in men aged 55–74. Approximately 80,000 men
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Abstract
The prostate portion of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial began in the early 1990s to assess the ability of annual PSA and DRE to reduce prostate cancer specific mortality in men aged 55–74. Approximately 80,000 men have been randomized and followed for a minimum of 13 years. Thus far, annual screening in this study has not been associated with a reduction of prostate cancer specific mortality. The potential explanations for this finding are reviewed.
Contents 1 Considerations for Interpreting the Results of the Prostate Portion of PLCO .................. 55 2 Further Follow-Up of the PLCO Trial ................................................................................ 56 References................................................................................................................................... 56
The PLCO Cancer Screening Trial is a multicenter randomized two-arm trial designed to evaluate the effects of screening for prostate, lung, colorectal, and ovarian cancer on disease-specific mortality. The trial was initiated in November 1993, and enrollment ended in 2001. The methods of recruitment for the PLCO Trial and randomization techniques have been previously described (Andriole et al. 2012). In brief, 76,685 men aged 55–74 were randomly assigned to the
G. L. Andriole (&) Division of Urologic Surgery, Washington University in Saint Louis, St. Louis, MO, USA e-mail: [email protected]
J. Cuzick and M. A. Thorat (eds.), Prostate Cancer Prevention, Recent Results in Cancer Research 202, DOI: 10.1007/978-3-642-45195-9_6, Springer-Verlag Berlin Heidelberg 2014
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G. L. Andriole
Fig. 1 Prostate cancer deaths in PLCO
intervention (or ‘‘screened’’) arm (38,240 subjects) or to the control arm (also referred to as the ‘‘usual care’’ arm) (38,345 subjects) at 10 screening centers throughout the United States. Men who were randomized to the screened arm were offered screening with annual serum PSAs for 6 years and digital rectal examination for 4 years. Screening for prostate cancer was completed in 2006. A serum PSA value [4 was considered a positive test as was a suspicious digital rectal examination. In PLCO, the participant and his healthcare provider were informed about the results of the screening tests and subsequent evaluation, such as additional or repeat diagnostic tests, biopsy, and therapy if cancer was discovered was performed outside of the trial. A description of follow-up of men with suspicious prostate screen(s) in PLCO was reported in 2008 (Grubb et al. 2008). Through 13 years of follow-up, there is an excess of prostate cancer cases in the screened arm (a relative increase of 12 % in comparison to the control arm). After 13 years of follow-up, mortality rates for prostate cancer in the intervention and control arms were not significantly different (see Fig. 1). No statistically significant interactions with respect to prostate cancer mortality were observed between the trial arms when age, the pretrial PSA testing, and c
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