Departments of Urology and Public Health (EWS), Erasmus University Medical Centre, Rotterdam, The Netherlands.
Departments of Urology and Public Health (EWS), Erasmus University Medical Centre, Rotterdam, The Netherlands.
J Urol. 2015 Aug;194(2):336-42. doi: 10.1016/j.juro.2015.02.045. Epub 2015 Feb 16.
We assessed differences in treatment between the screening and control arms of ERSPC Rotterdam and studied whether possible treatment differences could explain the positive study outcome.
In ERSPC Rotterdam men 55 to 74 years old were randomized to a screening arm of 21,210 and a control arm of 21,166. Treatment after diagnosis was at the discretion of the care provider chosen by the patient. Initial treatment was compared in 4 risk groups. The relation between prostate cancer incidence and prostate cancer mortality was assessed by risk group by correlating the incidence RR and the mortality RR. A direct relation would have supported a stage shift as the main cause of changes in prostate cancer mortality.
Initial treatment differed between the arms in the low, intermediate and high risk groups but not in the metastatic group. The RRs of prostate cancer incidence and mortality per risk group were related 1:1 (regression line slope 1.00, 95% CI 0.30-1.74). Of changes in prostate cancer mortality 94% could be explained by changes in prostate cancer incidence. This made treatment differences unlikely as the reason for the observed decrease in prostate cancer mortality.
Differences in treatment between the ERSPC Rotterdam screening and control arms were unlikely to explain the differences in prostate cancer mortality. Results are instead consistent with a decrease in prostate cancer mortality as the result of a favorable stage through screening.
我们评估了 ERSPC Rotterdam 研究中筛查组和对照组之间的治疗差异，并研究了这些治疗差异是否可能解释研究阳性的结果。
ERSPC Rotterdam 研究中，55 至 74 岁的男性被随机分配到筛查组（21210 人）和对照组（21166 人）。确诊后的治疗由患者选择的医疗服务提供者决定。我们比较了 4 个风险组的初始治疗情况。通过比较发病率 RR 和死亡率 RR，评估前列腺癌发病率与前列腺癌死亡率之间的关系。如果存在直接关系，则支持以分期转移为主要原因导致前列腺癌死亡率变化。
在低危、中危和高危组中，筛查组和对照组之间的初始治疗存在差异，但在转移组中没有差异。每个风险组的前列腺癌发病率和死亡率的 RR 呈 1:1 相关（回归线斜率为 1.00，95%CI 0.30-1.74）。前列腺癌死亡率的变化中，94%可以用前列腺癌发病率的变化来解释。这表明治疗差异不太可能是观察到的前列腺癌死亡率下降的原因。
ERSPC Rotterdam 研究中筛查组和对照组之间的治疗差异不太可能解释前列腺癌死亡率的差异。结果与由于筛查而导致的有利分期导致前列腺癌死亡率下降一致。
