title: Quantifying the role of PSA screening in the US prostate cancer mortality decline.
abstract: OBJECTIVE
  To quantify the plausible contribution of prostate-specific antigen (PSA) screening to the nearly 30% decline in the US prostate cancer mortality rate observed during the 1990s.
  
  
  METHODS
  Two mathematical modeling teams of the US National Cancer Institute's Cancer Intervention and Surveillance Modeling Network independently projected disease mortality in the absence and presence of PSA screening. Both teams relied on Surveillance, Epidemiology, and End Results (SEER) registry data for disease incidence, used common estimates of PSA screening rates, and assumed that screening, by shifting disease from distant to local-regional clinical stage, confers a corresponding improvement in disease-specific survival.
  
  
  RESULTS
  The teams projected similar mortality increases in the absence of screening and decreases in the presence of screening after 1985. By 2000, the models projected that 45% (Fred Hutchinson Cancer Research Center) to 70% (University of Michigan) of the observed decline in prostate cancer mortality could be plausibly attributed to the stage shift induced by screening.
  
  
  CONCLUSIONS
  PSA screening may account for much, but not all, of the observed drop in prostate cancer mortality. Other factors, such as changing treatment practices, may also have played a role in improving prostate cancer outcomes.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA. retzioni@fhcrc.org
authors.forename: Ruth
authors.initials: R
authors.lastname: Etzioni
authors.forename: Alex
authors.initials: A
authors.lastname: Tsodikov
authors.forename: Angela
authors.initials: A
authors.lastname: Mariotto
authors.forename: Aniko
authors.initials: A
authors.lastname: Szabo
authors.forename: Seth
authors.initials: S
authors.lastname: Falcon
authors.forename: Jake
authors.initials: J
authors.lastname: Wegelin
authors.forename: Dante
authors.initials: D
authors.lastname: DiTommaso
authors.forename: Kent
authors.initials: K
authors.lastname: Karnofski
authors.forename: Roman
authors.initials: R
authors.lastname: Gulati
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.forename: Eric
authors.initials: E
authors.lastname: Feuer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005544:Forecasting; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D008962:Models, Theoretical; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D018426:SEER Program; D014481:United States / Q000453:epidemiology
chemical_list: D017430:Prostate-Specific Antigen