BERKELEY, CA (UroToday.com) - While there is increasing concern regarding over-diagnosis, prostate cancer mortality rates have fallen dramatically since the introduction of the PSA test.
Fewer patients are dying from prostate cancer now than in the pre-PSA era. Additionally, over-diagnosis is not caused by PSA testing, but by the way the PSA test results are used to guide biopsy referrals.
Our article suggests a new way to select if and when to perform PSA tests and how to use the resulting information to make decisions based on a patient’s risk of prostate cancer. A Markov model is used to estimate the age-specific biopsy referral policy that would maximize a patient’s quality adjusted life years (QALYs) and minimize the monetary costs of screening and treatment. The policy is based on the estimated risk of having prostate cancer - computed from PSA test results using Bayesian updating. The potential societal benefits of mass PSA screening are estimated in terms of QALYs and costs of screening and treatment. The differences in the optimal screening policies and the societal benefits of PSA screening are compared with and without considering monetary costs of screening and treatment. The comparison suggests that PSA screening should be discontinued approximately 5 years earlier when the monetary costs of screening are considered in addition to purely maximizing a given patient’s QALYs. Co-morbidities, the prostate cancer incidence rate, and the disutilities of prostate biopsy and treatment are among the factors that most influence the PSA screening policy. This implies that more aggressive mass PSA screening is needed if (1) people are living longer due to the improved outcomes of all the diseases, (2) more cancers are found, or (3) fewer complications and side effects result from advances in medical devices and practice.
Jingyu Zhang, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.