Professional Abstract
Objective
(1) To compare the effects of different frequencies of prostate specific antigen (PSA) surveillance after prostate cancer treatment on health outcomes; (2) To compare the effects of different post-treatment PSA surveillance frequencies on patient-reported anxiety and quality of life
Study Design
| Design Element |
Description |
| Design |
Observational: cohort study |
| Population |
Study 1: 10,479 men in the National Cancer Data Base with newly diagnosed localized prostate cancer between 2005 and 2010 who were treated with radiation therapy or radical prostatectomy and had complete follow-up through 2015
Study 2: 835 men with newly diagnosed localized prostate cancer between 2011 and 2013 treated with radiation therapy or radical prostatectomy who have been followed prospectively in the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study |
Interventions/
Comparators |
Number of PSA tests in the first year after prostate cancer treatment: 0–1; 2; 3+ |
| Outcomes |
Study 1: overall survival, time to recurrence, treatment for recurrent cancer
Study 2: patient-reported anxiety, cancer-specific health-related quality of life, global health-related quality of life
|
| Timeframe |
Study 1: median 8 years of follow-up
Study 2: 5-year follow-up |
Study 1. This observational cohort study used data from the National Cancer Data Base to compare three post-treatment PSA testing frequencies on overall survival and recurrence among 10,479 men with localized prostate cancer treated with surgery or radiation therapy. Of these men, 72% were non-Hispanic white, 13% were African American, and 15% were another race and/or Hispanic ethnicity. The average age was 63.
Researchers stratified men into six groups based on their low, medium, or high risk of prostate cancer recurrence and their initial treatment for prostate cancer, either surgery or radiation therapy. For all six strata, researchers categorized men into one of three comparator groups based on the number of PSA tests they received in the first year after treatment (zero or one, two, or three or more). Within each stratum, researchers compared study outcomes among the PSA testing frequencies.
Study 2. This study used data from the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study to compare the effect of three post-treatment PSA testing frequencies among 835 men with localized prostate cancer who received initial treatment with surgery or radiation therapy. Of these men, 66% were non-Hispanic white, 30% were African American, and 4% were another race and/or Hispanic ethnicity. The average age was 63 years.
Men completed surveys about prostate cancer-specific and global quality of life at enrollment, 3 and 12 months, and then annually thereafter; questions about prostate cancer-related anxiety began at 12 months. Researchers compared changes in these outcomes through five years of follow-up among the PSA testing frequencies.
Prostate cancer survivors and oncologists helped plan the study.
Results
Objective 1. In each of the six strata, researchers found no significant differences in overall survival, time to prostate cancer recurrence, or treatment for prostate cancer recurrence among the three post-treatment PSA testing frequencies.
Objective 2. Changes in patient-reported anxiety and prostate cancer-specific and global quality of life did not differ significantly by frequency of post-treatment PSA testing.
Limitations
The first-year PSA testing frequencies may not reflect testing frequencies in subsequent years. Study 1 may have been underpowered to detect meaningful differences in overall survival over a median follow-up of eight years. In study 2, response rates for patient-reported measures decreased with longer follow-up, leading to missing data that could bias results.
Conclusions and Relevance
Frequency of PSA testing in the first year after treatment with surgery or radiation therapy was not associated with differences in overall survival, detection of recurrence, or changes in prostate cancer-related anxiety or quality of life in men with localized prostate cancer.
Future Research Needs
Future research could follow patients for longer to evaluate the association between frequency of post-treatment PSA testing and prostate cancer recurrence or overall survival.
