1728 EARLY DETECTION OF PROSTATE CANCER (TYROL PROSTATE CANCER DEMONSTRATION PROJECT 1988-2008): 20 YEARS EXPERIENCE

Article Outline

• INTRODUCTION AND OBJECTIVES
• METHODS
• RESULTS
• CONCLUSIONS
• Copyright

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INTRODUCTION AND OBJECTIVES 

To evaluate the effectiveness of a well-controlled programme of early detection and treatment of prostate cancer in the population of Tyrol, Austria, where such a programme of early detection and treatment was initiated in 1988 and where prostate –specific antigen (PSA) testing was offered for free to all men aged 45-75 years from 1993.

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METHODS 

In 1988, the concept of early detection and curative radical therapy for prostate cancer was introduced in the Tyrol. In 2005 a cumulative testing rate of 86.6% was achieved. Overall 8054 transrectal ultrasound-guided biopsies were performed; before 1998 ten biopsies were obtained with the B-mode, subsequently five additional biopsies were performed using contrast-enhanced color Doppler ultrasound. In men with organ-confined lesions surgical removal of the prostate was recommended; 86.3% of patients with T1 or T2 disease were treated with low-morbidity radical prostatectomy, 8.7% with brachytherapy, and 8.7% with radiotherapy. Between 1988 and 2008 2153 radical prostatectomies were performed mostly by two surgeons (G.B., W.H.). Patients presenting with T3 lesions underwent external beam radiotherapy.

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RESULTS 

Radical prostatectomy has been associated with low morbidity; 30-day mortality was zero and none of the patients suffered a ureteral injury. The rectal injury rate dropped to 0.1% from 0.6% before the year 2000. Only 0.7% of the patients had postoperative bleeding requiring intervention. One year after surgery, 95.1% of men were continent (no pads) and potency could be preserved in 78.9% of men below 65 years of age. The morbidity associated with transrectal ultrasound-guided biopsy was low; major complications were seen in a small percentage of patients only (0.8% of patients with fevers higher than 100.4°F required hospitalization). Since 1996 a significant reduction in mortality from prostate cancer has been observed in the Tyrol. In the years 2003-2008 prostate cancer mortality rates decreased by 48%, 55%, 52%, 49%, 41%, and 64% (2008) respectively.

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CONCLUSIONS 

These findings confirm the hypothesis that freely available PSA testing, which has met with wide acceptance in the population, is associated with a reduction in prostate cancer mortality in an area where effective treatment is freely available to all men. It is likely that much of this decline in mortality rates is due to earlier detection and successful treatment of prostate cancer. However, and important corollary implication of our study is that screening is only the first step in the optimal management of prostate cancer.