Effect of patient age on early detection of prostate cancer with serum prostate-specific antigen and digital rectal examination

Richie, Jerome P.; Catàlona, William J.; Ahmann, Frederick R.; Hudson, M’Liss A.; Scardino, Peter T.; Flanigan, Robert C.; deKernion, Jean B.; Ratliff, Timothy L.; Kavoussi, Louis R.; Dalkin, Bruce L.; Waters, W. Bedford; Macfarlane, Michael T.; Southwick, Paula C.

doi:10.1016/0090-4295(93)90359-i

Cited by 188 publications

(113 citation statements)

References 12 publications

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“…33 This distribution does not accurately reflect the spectrum of disease seen in the United States. The prostate cancer screening trials used in the present study detected 77.6% moderately and poorly differentiated cancers in the PSA and DRE screening trial, 4 and 78.2% moderately and poorly differentiated cancers in the PSA alone screening trial. 5 This distribution of prostate cancer is more closely approximated by the study by Grö nberg et al used in the present analysis, which consisted of 68.6% moderately and poorly differentiated cancers.…”

Section: Discussionmentioning

confidence: 58%

“…4,5 The improved technique for radical prostatectomy, 32 coupled with the high cure rate for organ confined disease, provided a potential for a significant reduction in mortality from prostate cancer due to this early detection and treatment. Presently, there is insufficient data to conclusively determine what benefits, if any, accrue to men as a result of prostate cancer screening.…”

Section: Discussionmentioning

confidence: 99%

“…The costs of prostate cancer screening have been previously published 13 using the average allowed charges for Medicare as the fee schedule 14 and outcomes data from large, prostate screening trials 4,5 to estimate the cost per person screened up to the point of diagnosis. In the present model, it was assumed that all men found to have prostate cancer would undergo a radioisotope bone scan for staging purposes.…”

Section: Costs Of Screening and Stagingmentioning

confidence: 99%

“…24,25 Screening with PSA alone has increased the rate of detection of pathologically organ confined disease to 66% for men aged 50 -70, 5 while screening with PSA and DRE has increased the rate of detection of pathologically organ confined disease to 75% for men aged 50 -69. 4 To assess the effect of a lower rate of detection of pathologically organ confined disease by screening on the cost effectiveness of prostate cancer screening, a sensitivity analysis was performed to determine the cost per year of life saved if screening detected 10% (ie 65% in the PSA and DRE protocol and 56% in the PSA alone protocol) and 20% (ie 55% in the PSA and DRE protocol and 46% in the PSA alone protocol) less pathologically organ confined cancer. If the rate of detection of organ confined cancer is assumed to be 10% less than reported, the cost per life year saved would increase by 15.2% for men aged 50 -69 screened with PSA and DRE, and by 17.5% for men aged 50 -70 screened with PSA alone.…”

Section: Sensitivity Analysismentioning

confidence: 99%

“…It is estimated that 180 400 new cases of prostate cancer will be diagnosed in 2000 and that approximately 31 900 men will die from prostate cancer, making prostate cancer the most common cancer in men and the second leading cause of cancer death in men in this country. 3 Given the evidence that PSA screening will detect prostate cancer at an earlier stage, 4,5 accurate and meaningful cost and cost-effectiveness data on prostate cancer screening and treatment is critically needed.…”

Section: Introductionmentioning

confidence: 99%

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A quantitative analysis of the costs and benefits of prostate cancer screening

Benoit

Grönberg

Naslund

2001

Prostate Cancer Prostatic Dis

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The present study attempts to quantitate in an economically and clinically meaningful manner the cost and cost-effectiveness of prostate cancer screening and subsequent treatment, including complications from that treatment. Outcome data from large prostate cancer screening trials using prostate specific antigen (PSA) and digital rectal examination (DRE) and PSA alone were used to construct the screening model. The benefit of screening is expressed in years of life saved by screening, which is calculated by comparing the survival rate of men with prostate cancer to the survival rate of men in the general population. The cost of screening, treatment, and complications were estimated using the Medicare data base and published reports on the cost, morbidity and mortality for radical prostatectomy. The cost per year of life saved by prostate cancer screening with PSA and DRE was $2339 -3005 for men aged 50 -59, $3905 -5070 for men aged 60 -69, and $3574 -4627 overall for men aged 50 -69. The cost per year of life saved by prostate cancer screening with PSA alone for men aged 50 -70 was $3822 -4956. A sensitivity analysis demonstrates that the cost per year of life saved by prostate cancer screening will not change substantially even if the assumptions in this model have been underestimated or overestimated by 100%. This study quantifies only those parameters which can be reliably compared in concrete terms such as dollars, treatment impact on survival, published complication rates and published treatment costs. Using this type of analysis, prostate cancer screening appears to be a cost-effective intervention. However, the issue of whether prostate cancer screening is cost-effective will be decided definitively only when randomized, controlled trials are available to quantify the costs and benefits of prostate cancer screening. Prostate Cancer and Prostatic Diseases (2001) 4, 138-145.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%