Quantifying the role of PSA screening in the US prostate cancer mortality decline.
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.
Etzioni
Ruth
R
Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA. retzioni@fhcrc.org
Tsodikov
Alex
A
Mariotto
Angela
A
Szabo
Aniko
A
Falcon
Seth
S
Wegelin
Jake
J
DiTommaso
Dante
D
Karnofski
Kent
K
Gulati
Roman
R
Penson
David F
DF
Feuer
Eric
E
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
D017430:Prostate-Specific Antigen