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Natural experiment examining impact of aggressive screening and treatment on prostate cancer mortality in two fixed cohorts from Seattle area and Connecticut

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7367.740 (Published 05 October 2002) Cite this as: BMJ 2002;325:740
  1. Grace Lu-Yao, directora,
  2. Peter C Albertsen, professor of surgeryb,
  3. Janet L Stanford, member and head, Program in Prostate Cancer Researchc,
  4. Therese A Stukel, professor of biostatisticsd,
  5. Elizabeth S Walker-Corkery, research coordinatore,
  6. Michael J Barry, associate professor of medicine, Harvard Medical School (mbarry{at}partners.org)e
  1. aHealthStat, PO Box 7501, Princeton, NJ 08543, USA
  2. bDivision of Urology, Department of Surgery, University of Connecticut Health Center, MC 3955, Farmington, CT 06030, USA
  3. cDivision of Public Health Sciences, Programs in Epidemiology and Prostate Cancer Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, MW-814, Seattle, WA 98109, USA
  4. dCenter for the Evaluative Clinical Sciences, Dartmouth Medical School, 7251 Strasenburgh, Hanover, NH 03755, USA
  5. eMedical Practices Evaluation Center, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA 02114, USA
  1. Correspondence to: M J Barry
  • Accepted 24 June 2002

Abstract

Objective:To determine whether the more intensive screening and treatment for prostate cancer in the Seattle-Puget Sound area in 1987-90 led to lower mortality from prostate cancer than in Connecticut.

Design: Natural experiment comparing two fixed cohorts from 1987 to 1997.

Setting: Seattle-Puget Sound and Connecticut surveillance, epidemiology, and end results areas.

Participants: Population based cohorts of male Medicare beneficiaries aged 65-79 drawn from the Seattle (n=94 900) and Connecticut (n=120 621) areas.

Main outcome measures: Rates of screening for prostate cancer, treatment with radical prostatectomy and external beam radiotherapy, and prostate cancer specific mortality.

Results: The prostate specific antigen testing rate in Seattle was 5.39 (95% confidence interval 4.76 to 6.11) times that of Connecticut, and the prostate biopsy rate was 2.20 (1.81 to 2.68) times that of Connecticut during 1987-90. The 10 year cumulative incidences of radical prostatectomy and external beam radiotherapy up to 1996 were 2.7% and 3.9% for Seattle cohort members compared with 0.5% and 3.1% for Connecticut cohort members. The adjusted rate ratio of prostate cancer mortality up to 1997 was 1.03 (0.95 to 1.11) in Seattle compared with Connecticut.

Conclusion: More intensive screening for prostate cancer and treatment with radical prostatectomy and external beam radiotherapy among Medicare beneficiaries in the Seattle area than in the Connecticut area was not associated with lower prostate cancer specific mortality over 11 years of follow up.

Footnotes

  • Editorial by Thornton

  • Funding Agency for Health Care Research and Quality, grant Nos HS 08397 and HS 10278.

  • Competing interests None declared

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