Quality-of-life effects of prostate-specific antigen screening.
BACKGROUND
After 11 years of follow-up, the European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a 29% reduction in prostate-cancer mortality among men who underwent screening for prostate-specific antigen (PSA) levels. However, the extent to which harms to quality of life resulting from overdiagnosis and treatment counterbalance this benefit is uncertain.


METHODS
On the basis of ERSPC follow-up data, we used Microsimulation Screening Analysis (MISCAN) to predict the number of prostate cancers, treatments, deaths, and quality-adjusted life-years (QALYs) gained after the introduction of PSA screening. Various screening strategies, efficacies, and quality-of-life assumptions were modeled.


RESULTS
Per 1000 men of all ages who were followed for their entire life span, we predicted that annual screening of men between the ages of 55 and 69 years would result in nine fewer deaths from prostate cancer (28% reduction), 14 fewer men receiving palliative therapy (35% reduction), and a total of 73 life-years gained (average, 8.4 years per prostate-cancer death avoided). The number of QALYs that were gained was 56 (range, -21 to 97), a reduction of 23% from unadjusted life-years gained. To prevent one prostate-cancer death, 98 men would need to be screened and 5 cancers would need to be detected. Screening of all men between the ages of 55 and 74 would result in more life-years gained (82) but the same number of QALYs (56).


CONCLUSIONS
The benefit of PSA screening was diminished by loss of QALYs owing to postdiagnosis long-term effects. Longer follow-up data from both the ERSPC and quality-of-life analyses are essential before universal recommendations regarding screening can be made. (Funded by the Netherlands Organization for Health Research and Development and others.).
Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. e.heijnsdijk@erasmusmc.nl
Eveline A M
EA
Heijnsdijk
Elisabeth M
EM
Wever
Anssi
A
Auvinen
Jonas
J
Hugosson
Stefano
S
Ciatto
Vera
V
Nelen
Maciej
M
Kwiatkowski
Arnauld
A
Villers
Alvaro
A
Páez
Sue M
SM
Moss
Marco
M
Zappa
Teuvo L J
TL
Tammela
Tuukka
T
Mäkinen
Sigrid
S
Carlsson
Ida J
IJ
Korfage
Marie-Louise
ML
Essink-Bot
Suzie J
SJ
Otto
Gerrit
G
Draisma
Chris H
CH
Bangma
Monique J
MJ
Roobol
Fritz H
FH
Schröder
Harry J
HJ
de Koning
D000368:Aged; D003951:Diagnostic Errors / Q000009:adverse effects; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000523:psychology; D005060:Europe; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic
D017430:Prostate-Specific Antigen