Metastatic prostate cancer at diagnosis and through progression in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

• Published in: Cancer 2019-09, Vol.125 (17), p.2965-2974
• Main Authors: Pinsky, Paul F., Black, Amanda, Daugherty, Sarah E., Hoover, Robert, Parnes, Howard, Smith, Zachary L., Eggener, Scott, Andriole, Gerald L., Berndt, Sonja I.
• Format: Article
• Language: English
• Subjects: Aged; Antigens; Cancer screening; Diagnosis; Early Detection of Cancer; Humans; Intervention; Lung cancer; Male; Medical diagnosis; Medical screening; Metastases; Metastasis; metastatic disease; metastatic progression; Middle Aged; Oncology; Ovarian cancer; Prostate cancer; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - epidemiology; Prostatic Neoplasms - pathology; Rectum; screening; Survival; Survival Analysis
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.32176

Background The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial assessed the effect of screening with prostate‐specific antigen and a digital rectal examination on prostate cancer mortality. Another endpoint of interest was the burden of total metastatic disease. Methods All men in PLCO were assessed for metastatic prostate cancer at diagnosis; men with clinical stage I/II disease were assessed for metastatic progression. The rate of total metastatic disease was defined as metastases found either at diagnosis or through progression divided by person‐years (PYs) of follow‐up for all men in the trial. Metastatic progression rates were computed among men with clinical stage I/II prostate cancer. Survival among men with metastases at diagnosis was compared with survival among men with metastatic progression. Results Among 38,340 men in the intervention arm and 38,343 men in the control arm in PLCO, there were 4974 and 4699 prostate cancer cases, respectively. The rates of total metastatic disease were 4.72 and 4.83 per 10,000 PYs in the intervention and control arms, respectively (rate ratio, 0.98; 95% CI, 0.81‐1.18). The rates of metastatic progression among men with clinical stage I/II prostate cancer were 43.7 and 50.5 per 10,000 PYs in the intervention and control arms, respectively (P = .30). Prostate cancer–specific 5‐ and 10‐year survival rates were significantly worse for men with metastatic progression (24% and 19%, respectively) than men with metastases at diagnosis (40% and 26%, respectively). Conclusions Rates of total metastatic disease and metastatic progression were similar across arms in PLCO. Survival was worse for men with metastatic progression in comparison with those with metastatic disease at diagnosis. In the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, the total rates of metastatic prostate cancer (at diagnosis and through progression) are similar across trial arms. Rates of metastatic progression are similar across arms but increase with increasing prostate‐specific antigen levels and Gleason scores.