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Estimating the harms and benefits of prostate cancer screening as used in common practice versus recommended good practice : A microsimulation screening analysis

Carlsson, Sigrid V.; de Carvalho, Tiago M.; Roobol, Monique J.; Hugosson, Jonas; Auvinen, Anssi; Kwiatkowski, Maciej; Villers, Arnauld; Zappa, Marco; Nelen, Vera and Páez, Alvaro, et al. (2016) In Cancer 122(21). p.3386-3393
Abstract

BACKGROUND: 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.”. METHODS: 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... (More)

BACKGROUND: 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.”. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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;122:3386–3393.

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published
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keywords
early detection of cancer/adverse effects, mass screening, prostate-specific antigen/blood, prostatic neoplasms, quality of life, quality-adjusted-life-years
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Cancer
volume
122
issue
21
pages
8 pages
publisher
John Wiley & Sons
external identifiers
  • scopus:84979582997
  • wos:000388286000019
ISSN
0008-543X
DOI
10.1002/cncr.30192
language
English
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yes
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e2639370-d4b4-422a-98e4-7d7b4804d73a
date added to LUP
2016-11-11 13:52:13
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2017-11-16 00:01:00
@article{e2639370-d4b4-422a-98e4-7d7b4804d73a,
  abstract     = {<p>BACKGROUND: 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.”. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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;122:3386–3393.</p>},
  author       = {Carlsson, Sigrid V. and de Carvalho, Tiago M. and Roobol, Monique J. and Hugosson, Jonas and Auvinen, Anssi and Kwiatkowski, Maciej and Villers, Arnauld and Zappa, Marco and Nelen, Vera and Páez, Alvaro and Eastham, James A. and Lilja, Hans and de Koning, Harry J. and Vickers, Andrew J. and Heijnsdijk, Eveline A M},
  issn         = {0008-543X},
  keyword      = {early detection of cancer/adverse effects,mass screening,prostate-specific antigen/blood,prostatic neoplasms,quality of life,quality-adjusted-life-years},
  language     = {eng},
  month        = {11},
  number       = {21},
  pages        = {3386--3393},
  publisher    = {John Wiley & Sons},
  series       = {Cancer},
  title        = {Estimating the harms and benefits of prostate cancer screening as used in common practice versus recommended good practice : A microsimulation screening analysis},
  url          = {http://dx.doi.org/10.1002/cncr.30192},
  volume       = {122},
  year         = {2016},
}