Economic Analysis of Prostate-Specific Antigen Screening and Selective Treatment Strategies

Roth, Joshua A.; Gulati, Roman; Gore, John L.; Cooperberg, Matthew R.; Etzioni, Ruth

doi:10.1001/jamaoncol.2015.6275

Cited by 68 publications

(98 citation statements)

References 52 publications

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“…Despite agreement on the importance of conservative management to preserve screening benefits and reduce overtreatment [10], there is no consensus what to do next [11,12]. Conservative management encompasses two very different strategies: “watchful waiting” (WW) without curative intent and “active surveillance” (AS) with serial testing for “disease progression” to offer selective delayed treatment with curative intent.…”

Section: Introductionmentioning

confidence: 99%

Active Surveillance Versus Watchful Waiting for Localized Prostate Cancer: A Model to Inform Decisions

Loeb

Zhou

Siebert³

et al. 2017

European Urology

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Background An increasing proportion of prostate cancer is being managed conservatively. However, there are no randomized trials or consensus regarding the optimal follow-up strategy. Objective To compare life expectancy and quality of life between watchful waiting (WW) versus different strategies of active surveillance (AS). Design, setting, and participants A Markov model was created for US men starting at age 50, diagnosed with localized prostate cancer who chose conservative management by WW or AS using different testing protocols (prostate-specific antigen every 3–6 mo, biopsy every 1–5 yr, or magnetic resonance imaging based). Transition probabilities and utilities were obtained from the literature. Outcome measurements and statistical analysis Primary outcomes were life years and quality-adjusted life years (QALYs). Secondary outcomes include radical treatment, metastasis, and prostate cancer death. Results and limitations All AS strategies yielded more life years compared with WW. Lifetime risks of prostate cancer death and metastasis were, respectively, 5.42% and 6.40% with AS versus 8.72% and 10.30% with WW. AS yielded more QALYs than WW except in cohorts age >65 yr at diagnosis, or when treatment-related complications were long term. The preferred follow-up strategy was also sensitive to whether people value short-term over long-term benefits (time preference). Depending on the AS protocol, 30–41% underwent radical treatment within 10 yr. Extending the surveillance biopsy interval from 1 to 5 yr reduced life years slightly, with a 0.26 difference in QALYs. Conclusions AS extends life more than WW, particularly for men with higher-risk features, but this is partly offset by the decrement in quality of life since many men eventually receive treatment. Patient summary More intensive active surveillance protocols extend life more than watchful waiting, but this is partly offset by decrements in quality of life from subsequent treatment.

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Section: Introductionmentioning

confidence: 99%

Active Surveillance Versus Watchful Waiting for Localized Prostate Cancer: A Model to Inform Decisions

Loeb

Zhou

Siebert³

et al. 2017

European Urology

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“…Moreover, gradual increases in prostate cancer incidence have been reported4. This increased detection is most likely attributable to cancer screenings that measure prostate-specific antigen (PSA) levels15. There were 1.4 million cases of prostate cancer and 293,000 deaths worldwide in 20132.…”

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confidence: 99%

Prostate Cancer Mortality-To-Incidence Ratios Are Associated with Cancer Care Disparities in 35 Countries

Chen

Wang

et al. 2017

Sci Rep

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The variation in mortality-to-incidence ratios (MIRs) among countries reflects the clinical outcomes and the available interventions for colorectal cancer treatments. The association between MIR of prostate cancer and cancer care disparities among countries is an interesting issue that is rarely investigated. For the present study, cancer incidence and mortality rates were obtained from the GLOBOCAN 2012 database. The rankings and total expenditures on health of various countries were obtained from the World Health Organization (WHO). The association between variables was analyzed by linear regression analyses. In this study, we estimated the role of MIRs from 35 countries that had a prostate cancer incidence greater than 5,000 cases per year. As expected, high prostate cancer incidence and mortality rates were observed in more developed regions, such as Europe and the Americas. However, the MIRs were 2.5 times higher in the less developed regions. Regarding the association between MIR and cancer care disparities, countries with good WHO ranking and high total expenditures on health/gross domestic product (GDP) were significant correlated with low MIR. The MIR variation for prostate cancer correlates with cancer care disparities among countries further support the role of cancer care disparities in clinical outcome.

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“…Of the 30 (6%) patients who No. of follow-up visits 11 [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Data presented as median (IQR) or n (%). PSA, prostate specific antigen; IQR, interquartile range.…”

Section: Resultsmentioning

confidence: 99%

Can active surveillance really reduce the harms of overdiagnosing prostate cancer? A reflection of real life clinical practice in the PRIAS study

Drost¹,

Bangma²,

Kakehi³

et al. 2018

European Urology Supplements

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Background: Active surveillance (AS) for low-risk prostate cancer (PCa) appears to provide excellent longterm PCa-specific and overall survival. The choice for AS as initial treatment is mainly based on avoiding side effects from invasive treatment; but AS entails regular check-ups and the possibility of still having to switch or deciding to switch to invasive treatment. Here, we assessed the long-term follow-up data from AS in real life clinical practices.Methods: Data from the first 500 men, enrolled in PRIAS before July 2008 by 30 centers across 8 countries, were analyzed to provide long-term follow-up results. Men were advised to be regularly examined with prostate-specific antigen (PSA) tests, digital rectal examinations, and prostate biopsies. Men were advised to switch to invasive treatment if they had disease reclassification [Gleason score (GS) ≥3+4 on biopsy, more than two positive biopsy cores, a stage higher than cT2] or a PSA-doubling time of 0-3 years.We assessed time on AS, outcomes and reasons for discontinuing AS, and rates of potential unnecessary biopsies and treatments.Results: The median follow-up time was 6.5 years. During this period, 325 (65%) men discontinued after a median of 2.3 years and 121 (24%) men had no recent (>1 year) data-update after a median of 7.3 years. The remaining 54 (11%) men were confirmed to be still on AS. Most men discontinued based on protocol advice; 38% had other reasons. During follow-up, 838 biopsy sessions were performed of which 79% to 90% did not lead to reclassification, depending on the criteria. Of the 325 discontinued men, 112 subsequently underwent radical prostatectomy (RP), 126 underwent radiotherapy, 57 switched to watchful waiting (WW) or died, and 30 had another or unknown treatment. RP results were available of 99 men: 34% to 68%, depending on definition, had favorable outcomes; 50% of unfavorable the outcomes occurred in the first 2 years. Of the 30 (6%) men who died, 1 man died due to PCa.Conclusions: These data, reflecting real life clinical practice, show that more than half of men switched to invasive treatment within 2.3 years, indicating limitations to the extent in which AS is able to reduce the * All contributors to the data in this paper are listed in the Table S1. IntroductionSince the use of prostate specific antigen (PSA) testing, the majority of newly diagnosed prostate cancer (PCa) patients are considered to have low risk of progression (1). Although PSA screening leads to a PCa mortality reduction, overdiagnosis and overtreatment of these low-risk PCa patients are still a substantial concern (1-4). To prevent overtreatment, active surveillance (AS) is increasingly recognized as a favorable alternative to direct radical therapy for men with low-risk PCa (5-8). Considering all relevant data, the US Preventive Services Task Force (USPSTF) has recently proposed to endorse physicians to counsel men on PSA screening (9). This change in the USPSTF recommendation is heavily based on a modeling study which suggests that greater use of AS ...

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Economic Analysis of Prostate-Specific Antigen Screening and Selective Treatment Strategies

Cited by 68 publications

References 52 publications

Active Surveillance Versus Watchful Waiting for Localized Prostate Cancer: A Model to Inform Decisions

Active Surveillance Versus Watchful Waiting for Localized Prostate Cancer: A Model to Inform Decisions

Prostate Cancer Mortality-To-Incidence Ratios Are Associated with Cancer Care Disparities in 35 Countries

Can active surveillance really reduce the harms of overdiagnosing prostate cancer? A reflection of real life clinical practice in the PRIAS study

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