Cost-effectiveness of Prostate Cancer Screening: A Simulation Study Based on ERSPC Data

Heijnsdijk, Eveline A.M.; Carvalho, Tiago M. de; Auvinen, Anssi; Zappa, Marco; Nelen, Vera; Kwiatkowski, Maciej; Villers, Arnauld; Páez, Álvaro; Moss, Sue; Tammela, Teuvo L.J.; Recker, Franz; Denis, L.; Carlsson, Sigrid; Wever, Elisabeth M.; Bangma, Chris H.; Schröder, Fritz H.; Roobol, Monique J.; Hugosson, Jonas; Koning, Harry J. de

doi:10.1093/jnci/dju366

Cited by 134 publications

(165 citation statements)

References 40 publications

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“…with increased survival and decreased progression but at a substantial cost of overdetection and overtreatment. 12,20,21 Synthesizing these data, the U.S. Preventive Services Task Force recommended that population screening for prostate cancer should not be adopted as a public health policy, because risks appeared to outweigh benefits from detecting and treating PSA-detected disease. 22 The Cluster Randomised Trial of PSA Testing for Prostate Cancer (CAP) is assessing the effectiveness of population-based PSA testing.…”

Section: -Year Outcomes In Localized Prostate Cancermentioning

confidence: 99%

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer

Hamdy

Donovan

Lane³

et al. 2016

N Engl J Med

2,245

1,725

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms T h e ne w e ngl a nd jou r na l o f m e dicine n engl j med nejm.org This article was published on September 14, 2016, at NEJM.org. DOI: 10.1056/NEJMoa1606220Copyright © 2016 Massachusetts Medical Society. BACKGROUNDThe comparative effectiveness of treatments for prostate cancer that is detected by prostate-specific antigen (PSA) testing remains uncertain. METHODSWe compared active monitoring, radical prostatectomy, and external-beam radiotherapy for the treatment of clinically localized prostate cancer. Between 1999 and 2009, a total of 82,429 men 50 to 69 years of age received a PSA test; 2664 received a diagnosis of localized prostate cancer, and 1643 agreed to undergo randomization to active monitoring (545 men), surgery (553), or radiotherapy (545). The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up. Secondary outcomes included the rates of disease progression, metastases, and all-cause deaths. RESULTSThere were 17 prostate-cancer-specific deaths overall: 8 in the active-monitoring group (1.5 deaths per 1000 person-years; 95% confidence interval [CI], 0.7 to 3.0), 5 in the surgery group (0.9 per 1000 person-years; 95% CI, 0.4 to 2.2), and 4 in the radiotherapy group (0.7 per 1000 person-years; 95% CI, 0.3 to 2.0); the difference among the groups was not significant (P = 0.48 for the overall comparison). In addition, no significant difference was seen among the groups in the number of deaths from any cause (169 deaths overall; P = 0.87 for the comparison among the three groups). Metastases developed in more men in the active-monitoring group (33 men; 6.3 events per 1000 person-years; 95% CI, 4.5 to 8.8) than in the surgery group (13 men; 2.4 per 1000 person-years; 95% CI, 1.4 to 4.2) or the radiotherapy group (16 men; 3.0 per 1000 person-years; 95% CI, 1.9 to 4.9) (P = 0.004 for the overall comparison). Higher rates of disease progression were seen in the activemonitoring group (112 men; 22.9 events per 1000 person-years; 95% CI, 19.0 to 27.5) than in the surgery group (46 men; 8.9 events per 1000 person-years; 95% CI, 6.7 to 11.9) or the radiotherapy group (46 men; 9.0 events per 1000 person-years; 95% CI, 6.7 to 12.0) (P<0.001 for the overall comparison). CONCLUSIONSAt a median of 10 years, prostate-cancer-specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring.

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Section: -Year Outcomes In Localized Prostate Cancermentioning

confidence: 99%

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer

Hamdy

Donovan

Lane³

et al. 2016

N Engl J Med

2,245

1,725

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“…In addition, overdiagnosis and overtreatment of indolent cancers reduce patients' quality of life and increase their financial burden. 4 The PSA test has even lower specificity when PSA levels are in the range of 4-10 ng/mL, which is conventionally defined as gray zone; in this PSA range, only 25% of men who undergo biopsy are actually diagnosed with cancer. 5 Several PSA parameters have been reported to improve the specificity of detecting PCa early, including PSA density, PSA velocity, PSA doubling time, and f-PSA percentage.…”

Section: Introductionmentioning

confidence: 99%

Surface-enhanced Raman spectroscopy of serum accurately detects prostate cancer in patients with prostate-specific antigen levels of 4–10 ng/mL

Chen

Rong

Shao

et al. 2017

IJN

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The surface-enhanced Raman spectroscopy (SERS) of blood serum was investigated to differentiate between prostate cancer (PCa) and benign prostatic hyperplasia (BPH) in males with a prostate-specific antigen level of 4–10 ng/mL, so as to reduce unnecessary biopsies. A total of 240 SERS spectra from blood serum were acquired from 40 PCa subjects and 40 BPH subjects who had all received prostate biopsies and were given a pathological diagnosis. Multivariate statistical techniques, including principal component analysis (PCA) and linear discriminant analysis (LDA) diagnostic algorithms, were used to analyze the spectra data of serum from patients in control (CTR), PCa and BPH groups; results offered a sensitivity of 97.5%, a specificity of 100.0%, a precision of 100.0% and an accuracy of 99.2% for CTR; a sensitivity of 90.0%, a specificity of 97.5%, a precision of 94.7% and an accuracy of 98.3% for BPH; a sensitivity of 95.0%, a specificity of 93.8%, a precision of 88.4% and an accuracy of 94.2% for PCa. Similarly, this technique can significantly differentiate low- and high-risk PCa with an accuracy of 92.3%, a specificity of 95% and a sensitivity of 89.5%. The results suggest that analyzing blood serum using SERS combined with PCA–LDA diagnostic algorithms is a promising clinical tool for PCa diagnosis and assessment.

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“…Vickers et al [22] reports a 15-year risk of prostate cancer metastasis to be 0.09% from ages 45-49 and 0.28% from ages 51-55, supporting the conclusion that just three lifetime PSA tests would be sufficient for detecting clinically significant cancer in at least 50% of the male population. The cost-effectiveness of the screening diminishes in older patients due to loss of quality of life from overdiagnosis; data suggest that over the age of 60, only patients with PSA levels >2 ng/mL would benefit from continued screening [23,24]. In a sampling of men with nonmetastatic prostate cancer from the Prostate Cancer Outcomes Study, Daskivich et al [25] documented an other-cause mortality rate of greater than 50% for those with multiple comorbidities over the age of 60.…”

Section: Psa Screeningmentioning

confidence: 99%

The Risks and Benefits of Current Treatment Options for Prostate Cancer and Future Possibilities in Advanced Imaging and Targeted Therapy: A Review

Huebner

Barqawi²

2015

Arch Surg Oncol

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Cost-effectiveness of Prostate Cancer Screening: A Simulation Study Based on ERSPC Data

Abstract: Prostate cancer screening can be cost-effective when it is limited to two or three screens between ages 55 to 59 years. Screening above age 63 years is less cost-effective because of loss of QALYs because of overdiagnosis.

Cited by 134 publications

References 40 publications

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer

Surface-enhanced Raman spectroscopy of serum accurately detects prostate cancer in patients with prostate-specific antigen levels of 4–10 ng/mL

The Risks and Benefits of Current Treatment Options for Prostate Cancer and Future Possibilities in Advanced Imaging and Targeted Therapy: A Review

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Cost-effectiveness of Prostate Cancer Screening: A Simulation Study Based on ERSPC Data

Abstract: Prostate cancer screening can be cost-effective when it is limited to two or three screens between ages 55 to 59 years. Screening above age 63 years is less cost-effective because of loss of QALYs because of overdiagnosis.

Cited by 134 publications

References 40 publications

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer

Surface-enhanced Raman spectroscopy of serum accurately detects prostate cancer in patients with prostate-specific antigen levels of 4&ndash;10 ng/mL

The Risks and Benefits of Current Treatment Options for Prostate Cancer and Future Possibilities in Advanced Imaging and Targeted Therapy: A Review

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Surface-enhanced Raman spectroscopy of serum accurately detects prostate cancer in patients with prostate-specific antigen levels of 4–10 ng/mL