Prostate-specific antigen (PSA) screening and concomitant treatment can be implemented in several ways. The authors investigated how the net benefit of PSA screening varies between common practice versus "good practice. "
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Microsimulation screening analysis (MISCAN) was used to evaluate the effect on quality-adjusted life-years (QALYs) if 4 recommendations were followed: limited screening in older men, selective biopsy in men with elevated PSA, active surveillance for low-risk tumors, and treatment preferentially delivered at high-volume centers. Outcomes were compared with a base model in which annual screening started at ages 55 to 69 years and were simulated using data from the European Randomized Study of Screening for Prostate Cancer.
In terms of QALYs gained compared with no screening, for 1000 screened men who were followed over their lifetime, recommended good practice led to 73 life-years (LYs) and 74 QALYs gained compared with 73 LYs and 56 QALYs for the base model. In contrast, common practice led to 78 LYs gained but only 19 QALYs gained, for a greater than 75% relative reduction in QALYs gained from unadjusted LYs gained. The poor outcomes for common practice were influenced predominantly by the use of aggressive treatment for men with low-risk disease, and PSA testing in older men also strongly reduced potential QALY gains.
Commonly used PSA screening and treatment practices are associated with little net benefit. Following a few straightforward clinical recommendations, particularly greater use of active surveillance for low-risk disease and reducing screening in older men, would lead to an almost 4-fold increase in the net benefit of prostate cancer screening. Cancer 2016. © 2016 American Cancer Society.
Cancer. 2016 Jul 26 [Epub ahead of print]
Sigrid V Carlsson, Tiago M de Carvalho, Monique J Roobol, Jonas Hugosson, Anssi Auvinen, Maciej Kwiatkowski, Arnauld Villers, Marco Zappa, Vera Nelen, Alvaro Páez, James A Eastham, Hans Lilja, Harry J de Koning, Andrew J Vickers, Eveline A M Heijnsdijk
Deptartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York., Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands., Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands., Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden., School of Health Sciences, Tampere University, Tampere, Finland., Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland., Department of Urology, Lille University Hospital, University of Lille Nord de France, Lille, France., Unit of Clinical and Descriptive Epidemiology, Institute for Cancer Research and Prevention-ISPO, Florence, Italy., Provincial Institute for Hygiene, Antwerp, Belgium., Department of Urology, Fuenlabrada University Hospital, Madrid, Spain., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York., Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands., Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York., Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.