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1.
Center MM Jemal A Lortet-Tieulent J Ward E Ferlay J Brawley O Bray F 《European urology》2012,61(6):1079-1092
Context
Wide variation exists internationally for prostate cancer (PCa) rates due to differences in detection practices, treatment, and lifestyle and genetic factors.Objective
We present contemporary variations in PCa incidence and mortality patterns across five continents using the most recent data from the International Agency for Research on Cancer.Evidence acquisition
PCa incidence and mortality estimates for 2008 from GLOBOCAN are presented. We also examine recent trends in PCa incidence rates for 40 countries and mortality rates for 53 countries from 1985 and onward via join-point analyses using an augmented version of Cancer Incidence in Five Continents and the World Health Organization mortality database.Evidence synthesis
Estimated PCa incidence rates remain most elevated in the highest resource counties worldwide including North America, Oceania, and western and northern Europe. Mortality rates tend to be higher in less developed regions of the world including parts of South America, the Caribbean, and sub-Saharan Africa. Increasing PCa incidence rates during the most recent decade were observed in 32 of the 40 countries examined, whereas trends tended to stabilize in 8 countries. In contrast, PCa mortality rates decreased in 27 of the 53 countries under study, whereas rates increased in 16 and remained stable in 10 countries.Conclusions
PCa incidence rates increased in nearly all countries considered in this analysis except in a few high-income countries. In contrast, the increase in PCa mortality rates mainly occurred in lower resource settings, with declines largely confined to high-resource countries. 相似文献2.
Background
The European Randomised Study of Screening for Prostate Cancer (ERSPC) applies a prostate-specific antigen (PSA) cut-off value ≥3.0 ng/ml as an indication for lateralised sextant biopsy.Objective
To analyse the incidence and disease-specific mortality for prostate cancer (PCa) in men with an initial PSA <3.0 ng/ml.Design, setting and participants
From November 1993 to December 1999, a total of 42 376 men identified from population registries in the Rotterdam region (55–74 yr of age) were randomised to an intervention or control arm. A total of 19 950 men were screened during the first screening round.Intervention
A PSA <3.0 ng/ml was below the biopsy threshold. PCa cases were identified at rescreens every 4 yr or as interval cancers.Measurements
Distribution of incidence, aggressiveness, and disease-specific mortality of PCa per PSA range was measured. Causes of death were evaluated by an independent committee, and follow-up was complete until 31 December 2008.Results and limitations
From 1993 to 2008, 915 PCa cases were diagnosed in 15 758 men (5.8%) with an initial PSA <3.0 ng/ml and a median age of 62.3 yr. Median overall follow-up was 11 yr. PCa incidence increased significantly with higher initial PSA levels. Aggressive PCa (clinical stage ≥T2c, Gleason score ≥8, PSA >20 ng/ml, positive lymph nodes, or metastases at diagnosis) was detected in 66 of 733 screen-detected PCa cases (9.0%) and 72 of 182 interval-detected PCa cases (39.6%). Twenty-three PCa deaths occurred in the total population (0.15%), with an increasing risk of PCa mortality in men with higher initial PSA values.Conclusions
The risk of PCa, aggressive PCa and PCa mortality in a screening population with initial PSA <3.0 ng/ml increases significantly with higher initial PSA levels. These results contribute to the risk stratification and individual management of men in PSA-based screening programmes. 相似文献3.
Jennifer R. Rider Fredrik Sandin Ove Andrén Peter Wiklund Jonas Hugosson Pär Stattin 《European urology》2013
Background
Limited data exist on long-term outcomes among men with prostate cancer (PCa) from population-based cohorts incorporating information on clinical risk category.Objective
To assess 15-yr mortality for men with PCa treated with noncurative intent according to clinical stage, Gleason score (GS), serum levels of prostate specific antigen (PSA), comorbidity, and age.Design, setting, and participants
Register-based cohort study of 76 437 cases in the National Prostate Cancer Register (NPCR) of Sweden diagnosed from 1991 through 2009 and treated with noncurative intent. Each case was placed in one of five risk categories: (1) low risk: T1–T2 tumor, PSA level <10 ng/ml, and GS ≤6; (2) intermediate risk: T1–T2 tumor and PSA level 10–<20 ng/ml or GS 7; (3) high risk: T3 tumor or PSA level 20–<50 ng/ml or GS ≥8; (4) regional metastases: N1 or T4 tumor or PSA level 50–100 ng/ml; and (5) distant metastases: M1 tumor or PSA ≥100 ng/ml.Outcome measurements and statistical analysis
Ten- and 15-yr cumulative risk of death after diagnosis from PCa, cardiovascular disease, and other causes.Results and limitations
Among men with a Charlson Comorbidity Index (CCI) score of 0, no differences were found in observed versus expected all-cause mortality in the low-risk group. Observed mortality was only slightly greater in the intermediate-risk group, but men with high-risk localized PCa or more advanced disease had substantially higher mortality than expected. CCI was strongly associated with cumulative 10-yr mortality from causes other than PCa, especially for men <65 yr. Limitations include potential misclassification in risk category due to GS assignment.Conclusions
PCa mortality rates vary 10-fold according to risk category. The risk of death from causes other than PCa is most strongly related to comorbidity status in younger men. 相似文献4.
Background
It is largely unknown whether prostate-specific antigen (PSA) level at first date of testing predicts long-term risk of prostate cancer (PCa) incidence and mortality in the general population.Objective
Determine whether baseline PSA levels predict long-term risk of PCa incidence and mortality.Design, setting, and participants
We examined 4383 men aged 20–94 yr from the Danish general population in the prospective Copenhagen City Heart Study. PSA was measured in plasma samples obtained in 1981–1983.Measurements
PCa incidence and mortality as a function of baseline PSA was assessed using Kaplan-Meier plots of cumulative incidence and competing risk subhazard ratios.Results and limitations
During 28 yr of follow-up, 170 men developed PCa, and 94 men died from PCa. Median follow-up was 18 yr (range: 0.5–28 yr). For PCa incidence, the subhazard ratio was 3.0 (95% confidence interval [CI], 1.9–4.6) for a PSA level of 1.01–2.00 ng/ml, 6.8 (95% CI, 4.2–11) for PSA 2.01–3.00 ng/ml, 6.6 (95% CI, 3.4–13) for PSA 3.01–4.00 ng/ml, 16 (95% CI, 10.4–25) for PSA 4.01–10.00 ng/ml, and 57 (95% CI, 32–104) for PSA >10.00 ng/ml versus 0.01–1.00 ng/ml. For PCa mortality, corresponding subhazard ratios were 2.2 (95% CI, 1.3–3.9), 5.1 (95% CI, 2.8–9.0), 4.2 (95% CI, 1.8–10), 7.0 (95% CI, 3.8–14), and 14 (95% CI, 6.0–32). For men with PSA levels of 0.01–1.00 ng/ml, the absolute 10-yr risk of PCa was 0.6% for ages <45 yr, 0.7% for ages 45–49 yr, 1.1% for ages 50–54 yr, 1.2% for ages 55–59 yr, 1.3% for ages 60–64 yr, 1.1% for ages 65–69 yr, 1.3% for ages 70–74 yr, and 1.5% for ages ≥75 yr; corresponding values for PSA levels >10.00 ng/ml were 35%, 41%, 63%, 71%, 77%, 69%, 75%, and 88%, respectively.Conclusions
Stepwise increases in PSA at first date of testing predicted a 3–57-fold increased risk of PCa, a 2–16-fold increased risk of PCa mortality, and a 35–88% absolute 10-yr risk of PCa in men with PSA levels >10.00 ng/ml. Equally important, the absolute 10-yr risk of PCa in men with PSA levels 0.01–1.00 ng/ml was only 0.6–1.5%. 相似文献5.
Background
In a previous publication from the Göteborg randomised screening trial from 2010, biennial prostate-specific antigen (PSA) screening for men ≤69 yr of age was shown to lower prostate cancer (PCa) mortality by 44%. The evidence of the optimal age to stop screening, however, is limited.Objective
To examine the risk of PCa after the discontinuation of screening.Design, setting, and participants
In December 1994, 20 000 men in Göteborg, Sweden, between the ages of 50 and 65 yr were randomised to a screening arm (invited biennially to PSA testing) and a control arm (not invited). At the upper age limit (average: 69 yr), a total of 13 423 men (6449 and 6974 in the screening and control arms, respectively) were still alive without PCa. The incidence of PCa hereafter was established by matching with the Western Swedish Cancer Register. Participants were followed until a diagnosis of PCa, death, or final follow-up on June 30, 2012, or for a maximum of 12 yr after the last invitation.Outcome measurements and statistical analysis
Incidence rates and disease-free survival were calculated with life table models and Kaplan-Meier estimates. A competing risk model was also applied.Results and limitations
Postscreening, 173 cases of PCa were diagnosed in the screening arm (median follow-up: 4.8 yr) and 371 in the control arm (median follow-up: 4.9 yr). Up to 9 yr postscreening, all risk groups were more commonly diagnosed in the control arm, but after 9 yr the rates in the screening arm caught up, other than those for the low-risk group. PCa mortality also caught up after 9 yr.Conclusions
Nine years after the termination of PSA testing, the incidence of potentially lethal cancers equals that of nonscreened men. Considering the high PCa mortality rate in men >80 yr of age, a general age of 70 yr to discontinue screening might be too low. Instead, a flexible age to discontinue based on individual risk stratification should be recommended. 相似文献6.
Background
It remains unclear whether adding long-term prostate-specific antigen velocity (PSAV) to baseline PSA values improves classification of prostate cancer (PCa) risk and mortality in the general population.Objective
To determine whether long-term PSAV improves classification of PCa risk and mortality in the general population.Design, setting, and participants
We studied 503 men aged 30–80 yr, with and without PCa, who had repeated PSA measurements over 20 yr and up to 28 yr before PCa diagnosis. These were selected from among 7455 men in the Copenhagen City Heart Study, a prospective, general population study with follow-up from 1981 through 2010. Results were subsequently applied to all 1 351 441 men aged 40–80 yr living in Denmark from 1997 through 2006.Outcome measurements and statistical analysis
PCa risk and mortality were assessed using Cox regression. Improvement in risk classification was assessed using the net reclassification index (NRI).Results
Age-adjusted hazard ratios for PCa risk and mortality were 2.7–5.3 and 2.3–3.4, respectively, for long-term PSAV when added to models already including baseline PSA values. For PCa risk and mortality, adding long-term PSAV to models already including baseline PSA values and age yielded continuous NRIs of 98–99% and 56–106%, respectively. Used on a nationwide scale (eg, for men aged 60–64 yr), long-term PSAV >0.35 versus ≤0.35 ng/ml per year appropriately reclassified 128 of 10 000 men with PCa and 8095 of 10 000 men with no PCa. Correspondingly, inappropriately reclassified were 49 of 10 000 men with PCa and 1658 of 10 000 men with no PCa.Conclusions
Long-term PSAV in addition to baseline PSA value improves classification of PCa risk and mortality. Applying long-term PSAV nationwide, the ratio of appropriately to inappropriately classified men would typically be 5:1. 相似文献7.
Context
An association between tobacco smoking and prostate cancer (PCa) incidence and mortality was suggested in an earlier meta-analysis of 24 prospective studies in which dose–response associations and risks per unit of tobacco use were not examined.Objective
We investigated the association between several measures of tobacco use and PCa mortality (primary outcome) and incidence (secondary outcome) including dose–response association.Evidence acquisition
Relevant articles from prospective studies were identified by searching the PubMed and Web of Science databases (through January 21, 2014) and reference lists of relevant articles. Combined relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects methods. We also calculated population attributable risk (PAR) for smoking and PCa mortality.Evidence synthesis
We included 51 articles in this meta-analysis (11 823 PCa deaths, 50 349 incident cases, and 4 082 606 cohort participants). Current cigarette smoking was associated with an increased risk of PCa death (RR: 1.24; 95% CI, 1.18–1.31), with little evidence for heterogeneity and publication bias. The number of cigarettes smoked per day had a dose–response association with PCa mortality (p = 0.02; RR for 20 cigarettes per day: 1.20). The PAR for cigarette smoking and PCa deaths in the United States and Europe were 6.7% and 9.5%, respectively, corresponding to >10 000 deaths/year in these two regions. Current cigarette smoking was inversely associated with incident PCa (RR: 0.90; 95% CI, 0.85–0.96), with high heterogeneity in the results. However, in studies completed in 1995 or earlier (considered as completed before the prostate-specific antigen screening era), ever smoking showed a positive association with incident PCa (RR: 1.06; 95% CI, 1.00–1.12) with little heterogeneity.Conclusions
Combined evidence from observational studies shows a modest but statistically significant association between cigarette smoking and fatal PCa. Smoking appears to be a modifiable risk factor for PCa death.Patient summary
Smoking increases the chance of prostate cancer death. Not smoking prevents this harm and many other tobacco-related diseases. 相似文献8.
Axel Heidenreich Per-Anders Abrahamsson Walter Artibani James Catto Francesco Montorsi Hein Van Poppel Manfred Wirth Nicolas Mottet 《European urology》2013
Background
The recommendations and the updated EAU guidelines consider early detection of PCa with the purpose of reducing PCa-related mortality and the development of advanced or metastatic disease.Objective
This paper presents the recommendations of the European Association of Urology (EAU) for early detection of prostate cancer (PCa) in men without evidence of PCa-related symptoms.Evidence acquisition
The working panel conducted a systematic literature review and meta-analysis of prospective and retrospective clinical studies on baseline prostate-specific antigen (PSA) and early detection of PCa and on PCa screening published between 1990 and 2013 using Cochrane Reviews, Embase, and Medline search strategies.Evidence synthesis
The level of evidence and grade of recommendation were analysed according to the principles of evidence-based medicine. The current strategy of the EAU recommends that (1) early detection of PCa reduces PCa-related mortality; (2) early detection of PCa reduces the risk of being diagnosed and developing advanced and metastatic PCa; (3) a baseline serum PSA level should be obtained at 40–45 yr of age; (4) intervals for early detection of PCa should be adapted to the baseline PSA serum concentration; (5) early detection should be offered to men with a life expectancy ≥10 yr; and (6) in the future, multivariable clinical risk-prediction tools need to be integrated into the decision-making process.Conclusions
A baseline serum PSA should be offered to all men 40–45 yr of age to initiate a risk-adapted follow-up approach with the purpose of reducing PCa mortality and the incidence of advanced and metastatic PCa. In the future, the development and application of multivariable risk-prediction tools will be necessary to prevent over diagnosis and over treatment. 相似文献9.
Johan Stranne Eva Johansson Andreas Nilsson Anna Bill-Axelson Stefan Carlsson Lars Holmberg Jan-Erik Johansson Tommy Nyberg Mirja Ruutu N. Peter Wiklund Gunnar Steineck 《European urology》2010
Background
Observational data indicate that retropubic radical prostatectomy (RRP) for prostate cancer (PCa) may induce inguinal hernia (IH) formation. Little is known about the influence of robot-assisted radical prostatectomy (RALP) on IH risk.Objective
To compare the incidence of IH after RRP and RALP to that of nonoperated patients with PCa and to a population control.Design, setting, and participants
We studied two groups. All 376 men included in the Scandinavian Prostate Cancer Group Study Number 4 constitute study group 1. Patients were randomly assigned RRP or watchful waiting (WW). The 1411 consecutive patients who underwent RRP or RALP at Karolinska University Hospital constitute study group 2. Men without PCa, matched for age and residence to each study group, constitute controls.Measurements
Postoperative IH incidence was detected through a validated questionnaire. The participation rates were 82.7% and 88.4% for study groups 1 and 2, respectively.Results and limitations
The Kaplan-Meier cumulative occurrence of IH development after 48 mo in study group 1 was 9.3%, 2.4%, and 0.9% for the RRP, the WW, and the control groups, respectively. There were statistically significant differences between the RRP group and the WW and control groups, but not between the last two. In study group 2 the cumulative risk of IH development at 48 mo was 12.2%, 5.8%, and 2.6% for the RRP, the RALP, and the control group, respectively. There were statistically significant differences between the RRP group and the RALP and control groups, but not between the last two.Conclusions
RRP for PCa leads to an increased risk of IH development. RALP may lower the risk as compared to open surgery. 相似文献10.
Stacy Loeb Marc A. Bjurlin Joseph Nicholson Teuvo L. Tammela David F. Penson H. Ballentine Carter Peter Carroll Ruth Etzioni 《European urology》2014
Context
Although prostate cancer (PCa) screening reduces the incidence of advanced disease and mortality, trade-offs include overdiagnosis and resultant overtreatment.Objective
To review primary data on PCa overdiagnosis and overtreatment.Evidence acquisition
Electronic searches were conducted in Cochrane Central Register of Controlled Trials, PubMed, and Embase from inception to July 2013 for original articles on PCa overdiagnosis and overtreatment. Supplemental articles were identified through hand searches.Evidence synthesis
The lead-time and excess-incidence approaches are the main ways used to estimate overdiagnosis in epidemiological studies, with estimates varying widely. The estimated number of PCa cases needed to be diagnosed to save a life has ranged from 48 down to 5 with increasing follow-up. In clinical studies, generally lower rates of overdiagnosis have been reported based on the frequency of low-grade minimal tumors at radical prostatectomy (1.7–46.8%). Autopsy studies have reported PCa in 18.5–38.5%, although not all are low grade or low volume. Factors influencing overdiagnosis include the study population, screening protocol, and background incidence, limiting generalizability between settings. Reported rates of overtreatment vary widely in the literature, although contemporary international studies suggest increasing use of conservative management.Conclusions
Epidemiological, clinical, and autopsy studies have been used to examine PCa overdiagnosis, with estimates ranging widely from 1.7% to 67%. Correspondingly, estimates of overtreatment vary widely based on patient features and may be declining internationally. Careful patient selection for screening and reducing overtreatment are important to preserve the benefits and reduce the downstream harms of prostate-specific antigen testing. Because all of these estimates are extremely population and context specific, this must be considered when using these data to inform policy.Patient summary
Screening reduces spread and death from prostate cancer (PCa) but overdiagnoses some low-risk tumors that may not have caused harm. Because treatment has potential side effects, it is critical that not all patients with PCa receive aggressive treatment. 相似文献11.
Context
Prostate cancer (PCa) remains one of the most diagnosed malignancies in the world, correlating with regions where men consume more of a so-called Western-style diet. As such, there is much interest in understanding the role of lifestyle and diet on the incidence and progression of PCa.Objective
To provide a summary of published literature with regard to dietary macro- and micronutrients and PCa incidence and progression.Evidence acquisition
A literature search was completed using the PubMed database for all studies published on diet and PCa in June 2012 or earlier. Primary literature and meta-analyses were given preference over other review articles when possible.Evidence synthesis
The literature was reviewed on seven dietary components: carbohydrates, protein, fat and cholesterol, vegetables, vitamins and minerals, and phytochemicals. Current literature linking these nutrients to PCa is limited at best, but trends in the published data suggest consumption of carbohydrates, saturated and ω-6 fats, and certain vitamin supplements may promote PCa risk and progression. Conversely, consumption of many plant phytochemicals and ω-3 fatty acids seem to slow the risk and progression of the disease. All other nutrients seem to have no effect or data are inconclusive. A brief summary about the clinical implications of dietary interventions with respect to PCa prevention, treatment, and survivorship is provided.Conclusions
Due to the number and heterogeneity of published studies investigating diet and PCa, it is difficult to determine what nutrients make up the perfect diet for the primary and secondary prevention of PCa. Because diets are made of multiple macro- and micronutrients, further prospective studies are warranted, particularly those investigating the relationship between whole foods instead of a single nutritional component. 相似文献12.
Context
Obesity and prostate cancer (PCa) affect substantial proportions of Western society. Mounting evidence, both epidemiologic and mechanistic, for an association between the two is of public health interest. An improved understanding of the role of this modifiable risk factor in PCa etiology is imperative to optimize screening, treatment, and prevention.Objective
To consolidate and evaluate the evidence for an epidemiologic link between obesity and PCa, in addition to examining the proposed underlying molecular mechanisms.Evidence acquisition
A PubMed search for relevant articles published between 1991 and July 2012 was performed by combining the following terms: obesity, BMI, body mass index and prostate cancer risk, prostate cancer incidence, prostate cancer mortality, radical prostatectomy, androgen-deprivation therapy, external-beam radiation, brachytherapy, prostate cancer and quality of life, prostate cancer and active surveillance, in addition to obesity, BMI, body mass index and prostate cancer and insulin, insulin-like growth factor, androgen, estradiol, leptin, adiponectin, and IL-6. Articles were selected based on content, date of publication, and relevancy, and their references were also searched for relevant articles.Evidence synthesis
Increasing evidence suggests obesity is associated with elevated incidence of aggressive PCa, increased risk of biochemical failure following radical prostatectomy and external-beam radiotherapy, higher frequency of complications following androgen-deprivation therapy, and increased PCa-specific mortality, although perhaps a lower overall PCa incidence. These results may in part relate to difficulties in detecting and treating obese men. However, multiple molecular mechanisms could explain these associations as well. Weight loss slows PCa in animal models but has yet to be fully tested in human trials.Conclusions
Obesity appears to be linked with aggressive PCa. We suggest clinical tips to better diagnose and treat obese men with PCa. Whether reversing obesity slows PCa growth is currently unknown, although it is an active area of research. 相似文献13.
Timothy J. Daskivich Lorna Kwan Atreya Dash Sheldon Greenfield Mark S. Litwin 《European urology》2014
Background
Clinicians need a simple yet accurate method to predict other-cause mortality to inform medical decision making for men with prostate cancer (PCa).Objective
To compare weighted and unweighted Charlson Comorbidity Index scores in predicting long-term, other-cause mortality in men with early-stage PCa.Design, setting, and participants
A retrospective cohort study of 1482 men with early-stage PCa diagnosed in 1998–2004 at two Southern California Veterans Affairs medical centers.Outcome measurements and statistical analysis
Subhazard ratios and cumulative incidence of other-cause mortality associated with weighted and unweighted Charlson scores, calculated by competing-risks regression accounting for cancer mortality, along with Harrell concordance index (C-index) values.Results and limitations
Weighted and unweighted Charlson scores were identical in 88.6% of subjects (1313 of 1482 men) across all scores and in 91.7% of subjects (1359 of 1482 men) across scores of 0, 1, 2, and ≥3. In competing-risks analysis, hazards of other-cause mortality were similar when comparing weighted and unweighted scores. Men with weighted scores of 1, 2, and ≥3 (vs 0) had subhazard ratios of 2.3 (95% confidence interval [CI], 1.6–3.2), 4.1 (95% CI, 2.9–5.8), and 8.3 (95% CI, 5.9–11.5), respectively. Men with unweighted scores of 1, 2, and ≥3 (vs 0) had subhazard ratios of 2.5 (95% CI, 1.8–3.5), 4.5 (95% CI, 3.2–6.3), and 10.3 (95% CI, 7.2–14.7), respectively. The C-indexes for prediction of other-cause mortality were nearly identical for weighted scores (0.759 [95% CI, 0.715–0.780]) and unweighted scores (0.756 [95% CI, 0.717–0.780]). The difference in C-index between the two methods was −0.003 (95% CI, −0.01 to 0.004).Conclusions
An unweighted Charlson score yields similar strength of association and variance in predicting long-term, other-cause mortality compared with a weighted Charlson score.Patient summary
A simple count of major comorbidities provides similar accuracy to a weighted index in predicting death from other causes in men with early-stage prostate cancer. 相似文献14.
Background
The thorough assessment of familial prostate cancer (PCa) risk is as important as ever to provide a basis for clinical counselling and screening recommendations.Objective
Our aim was to determine the age-specific risks of PCa and the risk of death from PCa according to the number and the age of affected first-degree relatives.Design, setting, and participants
The nationwide Swedish Family-Cancer Database includes a record of >11.8 million individuals and their cancers from 1958 to 2006. All men from the database with identified parents (>3.9 million individuals) were followed between 1961 and 2006. The study included 26 651 PCa patients, of whom 5623 were familial.Measurements
The age-specific hazard ratios (HRs) of PCa and the HRs of death from PCa were calculated according to the number and age of affected fathers and brothers.Results and limitations
The HRs of PCa diagnosis increased with the number of affected relatives and decreased with increasing age. The highest HRs were observed for men <65 yr of age with three affected brothers (HR: approximately 23) and the lowest for men between 65 and 74 yr of age with an affected father (HR: approximately 1.8). The HRs increased with decreasing paternal or fraternal diagnostic age. The pattern of the risk of death from familial PCa was similar to the incidence data.Conclusions
The present results should guide clinical counselling and demonstrate the vast increases in risk when multiple first-degree relatives are affected. 相似文献15.
Fritz H. Schröder Jonas Hugosson Sigrid Carlsson Teuvo Tammela Liisa Määttänen Anssi Auvinen Maciej Kwiatkowski Franz Recker Monique J. Roobol 《European urology》2012
Background
Metastatic disease is a major morbidity of prostate cancer (PCa). Its prevention is an important goal.Objective
To assess the effect of screening for PCa on the incidence of metastatic disease in a randomized trial.Design, setting, and participants
Data were available for 76 813 men aged 55–69 yr coming from four centers of the European Randomized Study of Screening for Prostate Cancer (ERSPC). The presence of metastatic disease was evaluated by imaging or by prostate-specific antigen (PSA) values >100 ng/ml at diagnosis and during follow-up.Intervention
Regular screening based on serum PSA measurements was offered to 36 270 men randomized to the screening arm, while no screening was provided to the 40 543 men in the control arm.Outcome measurements and statistical analysis
The Nelson-Aalen technique and Poisson regression were used to calculate cumulative incidence and rate ratios of M+ disease.Results and limitations
After a median follow-up of 12 yr, 666 men with M+ PCa were detected, 256 in the screening arm and 410 in the control arm, resulting in cumulative incidence of 0.67% and 0.86% per 1000 men, respectively (p < 0.001). This finding translated into a relative reduction of 30% (hazard ratio [HR]: 0.70; 95% confidence interval [CI], 0.60–0.82; p = 0.001) in the intention-to-screen analysis and a 42% (p = 0.0001) reduction for men who were actually screened. An absolute risk reduction of metastatic disease of 3.1 per 1000 men randomized (0.31%) was found. A large discrepancy was seen when comparing the rates of M+ detected at diagnosis and all M+ cases that emerged during the total follow-up period, a 50% reduction (HR: 0.50; 95% CI, 0.41–0.62) versus the 30% reduction. The main limitation is incomplete explanation of the lack of an effect of screening during follow-up.Conclusions
PSA screening significantly reduces the risk of developing metastatic PCa. However, despite earlier diagnosis with screening, certain men still progress and develop metastases.The ERSPC trial is registered under number ISRCTN49127736. 相似文献16.
Context
Testicular cancer (TC) is the most common cancer in men aged 15–44 yr in many countries that score high or very high on the Human Development Index (HDI). Despite the very good prognosis for TC, wide variations in mortality rates have been reported internationally.Objective
To describe and contrast global variations and recent trends in TC incidence and mortality rates.Evidence acquisition
To compare TC incidence and mortality rates, we used GLOBOCAN 2008 estimates. We used the Cancer Incidence in Five Continents series to analyse recent trends in TC incidence in 41 countries by way of joinpoint analysis. To examine recent trends in mortality, we used the World Health Organisation mortality database.Evidence synthesis
Northern Europe remains the highest TC incidence area, with the highest rates observed in Norway and Denmark. Incidence rates continue to increase in most countries worldwide, more markedly in Southern Europe and Latin America, while attenuating in Northern Europe, the United States, and Australia. Mortality from TC shows a different pattern, with higher rates in some countries of medium to high HDI. The highest mortality rates were seen in Chile and Latvia, as well as in selected Central European and Eastern European countries. In high-income countries, TC mortality rates are declining or stable at very low levels of magnitude, while no significant decreases were observed in middle-income regions in Latin America and Asia.Conclusions
The rises in TC incidence appear to be recently attenuating in countries with the highest HDIs, with corresponding mortality rates either continuing to decline or stabilising at very low levels. In a number of countries transiting towards higher levels of development, the TC incidence is increasing while mortality rates are stable or increasing.Patient summary
In this study we looked at international testicular cancer trends. We found that testicular cancer is becoming more common in low- and middle-income countries, where the optimal treatment might not yet be available. 相似文献17.
Wu GH Auvinen A Yen AM Hakama M Tammela TL Stenman UH Kujala P Ruutu M Chen HH 《European urology》2012,61(5):1011-1018
Background
Population-based screening for prostate cancer (PCa) has used serum prostate-specific antigen (PSA) since the early 1990s. However, the efficacy could be affected by screening interval, age ranges of screening, attendance, and contamination of the control group in randomised controlled trials.Objective
Assess the impact of the above-mentioned factors on screening efficacy.Design, setting, and participants
Parameters pertaining to the natural history of PCa and sensitivity were estimated using data from the Finnish quadrennial screening program starting at 55 yr of age and terminating at 71 yr of age and comprising 80 458 men (32 000 in the screening arm and 48 458 in the control arm). We performed Markov decision analyses for different screening policies with a simulated 25-yr follow-up.Intervention
PSA screening.Measurements
The impact of different interscreening intervals and target age ranges on advanced PCa (stage III or worse) and PCa mortality was assessed.Results and limitations
With 65% attendance and 20% contamination, as in the Finnish trial, screening would result in an 11.1% (95% confidence interval [CI], 9.1–13.3%) reduction in advanced cancers and a 7.3% (95% CI, 5.3–9.7%) reduction in PCa death, with corresponding absolute risk difference of 2.6% (95% CI, 1.9–3.5%) and 1.8% (95% CI, 1.4–2.2%), respectively. Numbers needed to screen were 385 to prevent one case of advanced PCa and 556 to prevent one PCa death at 25 yr. Those figures remained similar from 12 yr onwards. Reduction in advanced PCa increased to 40% with annual screening and to 24% with biennial screening. When the age at screening initiation was increased by 5 yr, the benefit was reduced by 9% with annual screening and by 3% with biennial screening.Conclusions
We predicted the impact of basic screening characteristics on the benefit of the program. The screening interval (1–4 yr) had a greater impact on mortality reduction than did the age at start of screening (55–65 yr).Clinical trial registration
International Standard Randomised Controlled Trial Number (ISRCTN): ISRCTN49127736. 相似文献18.
Duke J Rea S Semmens J Wood F 《Burns : journal of the International Society for Burn Injuries》2012,38(4):591-598
Aim
To compare the incidence, temporal trends and cause of burn hospitalisations between urban, rural and remote regions in Western Australia, 1983–2008.Methods
De-identified linked hospital morbidity and mortality records for all persons hospitalised for an index burn in Western Australia were analysed 1983–2008. Annual age-specific incidence and age standardised rates were estimated. Poisson regression analyses were used to estimate temporal trends in hospital admissions by urban, rural and remote region.Results
Of 23,450 burn-related hospital admissions 1983–2008, 14,007 (59.7%) were in urban, 5442 (23.1%) rural and 4021 (17.2%) remote hospital regions. Hospitalisation rates were higher in rural (Incidence rate ratio (IRR), 95% CI: 1.5, 1.4–1.6) and remote (IRR, 95%C: 2.1, 2.0–2.2) regions compared to urban. Age-standardised rates of burn hospital admissions declined from 1983 to 2008 for each region with 26-year declines of 56% (95% CI: 51–60) for remote, 71% (95% CI: 68–73) for rural, and 9% (95% CI: 4–14) for admissions in urban regions. Scald was the most common cause for urban admissions while flame the most common cause for rural and remote burn admissions.Conclusions
Significant differences in the incidence, and cause of burn were identified between urban, rural and remote regions in Western Australia. 相似文献19.
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Irene M. Shui Sara Lindström Adam S. Kibel Sonja I. Berndt Daniele Campa Travis Gerke Kathryn L. Penney Demetrius Albanes Christine Berg H. Bas Bueno-de-Mesquita Stephen Chanock E. David Crawford W. Ryan Diver Susan M. Gapstur J. Michael Gaziano Graham G. Giles Brian Henderson Robert Hoover Mattias Johansson Loic Le Marchand Jing Ma Carmen Navarro Kim Overvad Fredrick R. Schumacher Gianluca Severi Afshan Siddiq Meir Stampfer Victoria L. Stevens Ruth C. Travis Dimitrios Trichopoulos Paolo Vineis Lorelei A. Mucci Meredith Yeager Edward Giovannucci Peter Kraft 《European urology》2014