Prostate-Specific Antigen Testing in Tyrol, Austria: Prostate Cancer Mortality Reduction Was Supported by an Update with Mortality

Objectives The objective of this study was to update an in-depth analysis of the time trend for prostate cancer (PCA) mortality in the population of Tyrol by 5 years, namely to 2008. In Tyrol, prostate-specific antigen (PSA) tests were introduced in 1988/89; more than three-quarters of all men in the age group 45–74 had at least one PSA test in the past decade. Methods We applied the same model as in a previous publication, i.e., an age-period-cohort model using Poisson regression, to the mortality data covering more than three decades from 1970 to 2008. Results For Tyrol from 2004 to 2008 in the age group 60? period terms show a significant reduction in prostate cancer mortality with a risk ratio of 0.70 (95% confidence interval 0.57, 0.87) for Tyrol, and for Austria excluding Tyrol a moderate reduction with a risk ratio of 0.92 (95% confidence interval 0.87, 0.97), each compared to the mortality rate in the period 1989–1993. Conclusions This update strengthens our previously published results, namely that PSA testing offered to a population at no charge can reduce prostate cancer mortality. The extent of mortality reduction is in line with that reported in the other recent publications. However, our data do not permit us to fully assess the harms associated with PCA screening, and no recommendation for PSA screening can be made without a careful evaluation of overdiagnosis and overtreatment. W. Oberaigner (&) Cancer Registry of Tyrol, TILAK GmbH, Anichstrasse 35, Innsbruck, Austria e-mail: [email protected] W. Oberaigner U. Siebert Department of Public Health and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall i.T, Austria W. Oberaigner U. Siebert Oncotyrol Division of Public Health Decision Modelling, Health Technology Assessment and Health Economics, Oncotyrol Center for Personalized Cancer Medicine, Innsbruck, Austria U. Siebert Cardiovascular Research Program, Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA U. Siebert Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA W. Horninger H. Klocker J. Bektic G. Bartsch Department of Urology, Innsbruck Medical University, Innsbruck, Austria G. Schäfer Department of Pathology, Innsbruck Medical University, Innsbruck, Austria F. Frauscher Department of Radiology, Innsbruck Medical University, Innsbruck, Austria H. Schennach Department of Immunology and Transfusion Medicine, Innsbruck Medical University, Innsbruck, Austria Int J Public Health (2012) 57:57–62 DOI 10.1007/s00038-011-0266-4