Prostatespecific antigen testing in Tyrol Austri

Authors: Willi Oberaigner Uwe Siebert Wolfgang Horninger Helmut Klocker Jasmin Bektic Georg Schäfer Ferdinand Frauscher Harald Schennach Georg Bartsch

Publish Date: 2011/06/17

Volume: 57, Issue: 1, Pages: 57-62

PDF Link

Abstract

The objective of this study was to update an indepth analysis of the time trend for prostate cancer PCA mortality in the population of Tyrol by 5 years namely to 2008 In Tyrol prostatespecific antigen PSA tests were introduced in 1988/89 more than threequarters of all men in the age group 45–74 had at least one PSA test in the past decadeFor Tyrol from 2004 to 2008 in the age group 60+ period terms show a significant reduction in prostate cancer mortality with a risk ratio of 070 95 confidence interval 057 087 for Tyrol and for Austria excluding Tyrol a moderate reduction with a risk ratio of 092 95 confidence interval 087 097 each compared to the mortality rate in the period 1989–1993This update strengthens our previously published results namely that PSA testing offered to a population at no charge can reduce prostate cancer mortality The extent of mortality reduction is in line with that reported in the other recent publications However our data do not permit us to fully assess the harms associated with PCA screening and no recommendation for PSA screening can be made without a careful evaluation of overdiagnosis and overtreatmentProstate cancer PCA is the secondleading cause of male cancer death in most industrialized countries Boyle et al 2008 One out of six men in the United States and in most industrialized countries will be affected by PCA during his lifetime SEER 2011 These facts explain why there is an exceptional interest in scientifically proven evidence on whether organized prostatespecific antigen PSA screening reduces PCA mortality and what harms are associated with such screening Until now screening healthy men for PCA has shown to be feasible and acceptable in the large studies De Koning et al 2002 The results of two large randomized studies with more than 75000 cases and controls in each study were recently published Schröder et al 2009 Andriole et al 2009 one showing a 20 reduction in the PCA death rate with a p value of 004 and the other showing no reductionTyrol is one of the few countries where PSA testing was introduced already as early as 1988/89 and since 1993 it has been offered to all men aged 45–74 Bartsch et al 2001 In 2006 we published an analysis of PCA mortality in Tyrol until the year of death 2003 and concluded that PSA testing offered free of charge to a population can reduce PCA mortality Oberaigner et al 2006 Critical questions were raised about the short observation period and too small numbers and therefore unstable results Recently the mortality data for Austria to year of death 2008 were released which enables us to update our analysis by adding 5 years to the observation period namely 2004–2008Mortality data were analyzed for Tyrol and for Austria excluding Tyrol In Austria mortality data are collected by Statistics Austria Hansluwka 1989 details are described elsewhere Oberaigner et al 2006 We analyzed all cases coded for cause of death PCA as described above

Keywords: