Ashley Kieran Clift1, Carol Ac Coupland2, Julia Hippisley-Cox1. 1. Professor of Clinical Epidemiology and Primary Care Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford. 2. School of Medicine, University of Nottingham, Nottingham.
Abstract
BACKGROUND: Prostate cancer is a leading cause of cancer- related death. Interpreting the results from trials of screening with prostate-specific antigen (PSA) is complex in terms of defining optimal prostate cancer screening policy. AIM: To assess the rates of, and factors associated with, the uptake of PSA testing and opportunistic screening (that is, a PSA test in the absence of any symptoms) in England between 1998 and 2017, and to estimate the likely rates of pre-randomisation screening and contamination (that is, unscheduled screening in the 'control' arm) of the UK-based Cluster Randomised Trial of PSA Testing for Prostate Cancer (CAP). DESIGN AND SETTING: Open cohort study of men in England aged 40-75 years at cohort entry (1998-2017), undertaken using the QResearch database. METHOD: Eligible men were followed for up to 19 years. Rates of PSA testing and opportunistic PSA screening were calculated; Cox regression was used to estimate associations. RESULTS: The cohort comprised 2 808 477 men, of whom 631 426 had a total of 1 720 855 PSA tests. The authors identified that 410 724 men had opportunistic PSA screening. Cumulative proportions of uptake of opportunistic screening in the cohort were 9.96% at 5 years', 22.71% at 10 years', and 44.13% at 19 years' follow-up. The potential rate of contamination in the CAP control arm was estimated at 24.50%. CONCLUSION: A substantial number of men in England opt in to opportunistic prostate cancer screening, despite uncertainty regarding its efficacy and harms. The rate of opportunistic prostate cancer screening in the population is likely to have contaminated the CAP trial, making it difficult to interpret the results.
BACKGROUND: Prostate cancer is a leading cause of cancer- related death. Interpreting the results from trials of screening with prostate-specific antigen (PSA) is complex in terms of defining optimal prostate cancer screening policy. AIM: To assess the rates of, and factors associated with, the uptake of PSA testing and opportunistic screening (that is, a PSA test in the absence of any symptoms) in England between 1998 and 2017, and to estimate the likely rates of pre-randomisation screening and contamination (that is, unscheduled screening in the 'control' arm) of the UK-based Cluster Randomised Trial of PSA Testing for Prostate Cancer (CAP). DESIGN AND SETTING: Open cohort study of men in England aged 40-75 years at cohort entry (1998-2017), undertaken using the QResearch database. METHOD: Eligible men were followed for up to 19 years. Rates of PSA testing and opportunistic PSA screening were calculated; Cox regression was used to estimate associations. RESULTS: The cohort comprised 2 808 477 men, of whom 631 426 had a total of 1 720 855 PSA tests. The authors identified that 410 724 men had opportunistic PSA screening. Cumulative proportions of uptake of opportunistic screening in the cohort were 9.96% at 5 years', 22.71% at 10 years', and 44.13% at 19 years' follow-up. The potential rate of contamination in the CAP control arm was estimated at 24.50%. CONCLUSION: A substantial number of men in England opt in to opportunistic prostate cancer screening, despite uncertainty regarding its efficacy and harms. The rate of opportunistic prostate cancer screening in the population is likely to have contaminated the CAP trial, making it difficult to interpret the results.
Authors: Richard M Martin; Jenny L Donovan; Emma L Turner; Chris Metcalfe; Grace J Young; Eleanor I Walsh; J Athene Lane; Sian Noble; Steven E Oliver; Simon Evans; Jonathan A C Sterne; Peter Holding; Yoav Ben-Shlomo; Peter Brindle; Naomi J Williams; Elizabeth M Hill; Siaw Yein Ng; Jessica Toole; Marta K Tazewell; Laura J Hughes; Charlotte F Davies; Joanna C Thorn; Elizabeth Down; George Davey Smith; David E Neal; Freddie C Hamdy Journal: JAMA Date: 2018-03-06 Impact factor: 56.272
Authors: Fritz H Schröder; Jonas Hugosson; Monique J Roobol; Teuvo L J Tammela; Stefano Ciatto; Vera Nelen; Maciej Kwiatkowski; Marcos Lujan; Hans Lilja; Marco Zappa; Louis J Denis; Franz Recker; Alvaro Páez; Liisa Määttänen; Chris H Bangma; Gunnar Aus; Sigrid Carlsson; Arnauld Villers; Xavier Rebillard; Theodorus van der Kwast; Paula M Kujala; Bert G Blijenberg; Ulf-Hakan Stenman; Andreas Huber; Kimmo Taari; Matti Hakama; Sue M Moss; Harry J de Koning; Anssi Auvinen Journal: N Engl J Med Date: 2012-03-15 Impact factor: 91.245
Authors: Fernand Labrie; Bernard Candas; Lionel Cusan; Jose Luis Gomez; Alain Bélanger; G Brousseau; Eric Chevrette; Jacques Lévesque Journal: Prostate Date: 2004-05-15 Impact factor: 4.104
Authors: Ashley Kieran Clift; Julia Hippisley-Cox; David Dodwell; Simon Lord; Mike Brady; Stavros Petrou; Gary S Collins Journal: BMJ Open Date: 2022-03-28 Impact factor: 2.692