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

You have accessJournal of UrologyProstate Cancer: Detection and Screening I1 Apr 20101728 EARLY DETECTION OF PROSTATE CANCER (TYROL PROSTATE CANCER DEMONSTRATION PROJECT 1988-2008): 20 YEARS EXPERIENCE Georg Bartsch, Wolfgang Horninger, Helmut Klocker, Wilhelm Oberaigner, Georg Schäfer, Ferdinand Frauscher, Chris Robertson, Mathieu Boniol, and Peter Boyle Georg BartschGeorg Bartsch Innsbruck, Austria More articles by this author , Wolfgang HorningerWolfgang Horninger Innsbruck, Austria More articles by this author , Helmut KlockerHelmut Klocker Innsbruck, Austria More articles by this author , Wilhelm OberaignerWilhelm Oberaigner Innsbruck, Austria More articles by this author , Georg SchäferGeorg Schäfer Innsbruck, Austria More articles by this author , Ferdinand FrauscherFerdinand Frauscher Innsbruck, Austria More articles by this author , Chris RobertsonChris Robertson Lyon, France More articles by this author , Mathieu BoniolMathieu Boniol Lyon, France More articles by this author , and Peter BoylePeter Boyle Lyon, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1576AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail 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. 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. 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. 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. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e667-e668 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Georg Bartsch Innsbruck, Austria More articles by this author Wolfgang Horninger Innsbruck, Austria More articles by this author Helmut Klocker Innsbruck, Austria More articles by this author Wilhelm Oberaigner Innsbruck, Austria More articles by this author Georg Schäfer Innsbruck, Austria More articles by this author Ferdinand Frauscher Innsbruck, Austria More articles by this author Chris Robertson Lyon, France More articles by this author Mathieu Boniol Lyon, France More articles by this author Peter Boyle Lyon, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...