Long-term projections of the harm-benefit trade-off in prostate cancer screening are more favorable than previous short-term estimates.
OBJECTIVE
To project long-term estimates of the number needed to screen (NNS) and the additional number needed to treat (NNT) to prevent one prostate cancer death with prostate-specific antigen (PSA) screening in Europe and in the United States.


METHODS
A mathematical model of disease-specific deaths in screened and unscreened men given information on overdiagnosis, disease-specific survival in the absence of screening, screening efficacy, and other-cause mortality is presented. A simulation framework is used to incorporate competing causes of death.


RESULTS
Assuming overdiagnosis and screening efficacy consistent with European Randomized study of Screening for Prostate Cancer (ERSPC) results, we project that, after 25 years, 262 men need to be screened and nine additional men need to be screen detected to prevent one prostate cancer death. Corresponding estimates of the NNS and the additional NNT under a range of overdiagnosis rates that are consistent with U.S. incidence are 186-220 and 2-5.


CONCLUSIONS
Long-term estimates of the NNS and the additional NNT are an order of magnitude lower than the short-term estimates published with the results of the ERSPC trial and may be consistent with cost-effective PSA screening in the general U.S. population.
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
Roman
R
Gulati
Angela B
AB
Mariotto
Shu
S
Chen
John L
JL
Gore
Ruth
R
Etzioni
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D055088:Early Detection of Cancer; D005060:Europe / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D014861:Washington / Q000453:epidemiology
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen