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EAU 2017

EAU 2017: Special session of the Prostate Cancer Prevention Group: PLCO

London, England (UroToday.com) The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial is a randomized, controlled trial to determine whether certain screening exams reduce mortality from prostate, lung, colorectal and ovarian cancer. Approximately 155,000 participants were enrolled between November 1993 and July 2001. The study was first published in 2009. Overall 76000 men were randomized in the prostate cancer component of the trial, in 10 study centers in the US. The most recent update of the trial included a median and maximum follow-up of 15 and 19 years, respectively. The study compared annual screening, including PSA tests for 6 years and digital rectal examination for 4 years, vs. usual care. Eligible patients were aged 55-74 and the primary endpoint was prostate cancer–specific mortality. Secondary endpoints included prostate cancer incidence, cancer stage and Gleason grade, survival, harms of screening, contamination and compliance, and all-cause mortality.

Results showed there were 255 deaths from prostate cancer in the intervention arm and 244 deaths from prostate cancer in the control arm; with a rate ratio (RR) of 1.04 (95% confidence interval [CI], 0.87-1.24), with no benefit in disease specific mortality. The RR for all-cause mortality was 0.977 (95% CI, 0.950-1.004).

In his presentation, Dr. Parnes described several possible reasons as to why there was not a mortality benefit in the intervention arm. These included:
1. The age of the cohort
2. Low biopsy rates
3. Definition of patient comorbidities which were too harsh, resulting in 64% of PLCO patients having a comorbidity
4. Prescreening (44% of patients in both arms had at least one PSA test before the trial)
5. Contamination, which reduced the power of the PLCO study, as 46% of the patients in the control arm had annual PSA testing and 86% of the patients had at least one PSA test during the trial duration.

To conclude, the extended 15 year median follow-up of the PLCO trial continues to indicate no reduction in prostate cancer mortality for the intervention arm versus the control arm. Because of the high rate of control-arm PSA testing, this finding can be viewed as demonstrating no benefit of organized screening versus opportunistic screening.

Presented by: H. Parnes, Bethesda (US)

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto

Twitter: @GoldbergHanan

at the #EAU17 -March 24-28, 2017- London, England