title: Comparative effectiveness of alternative prostate-specific antigen--based prostate cancer screening strategies: model estimates of potential benefits and harms.
abstract: BACKGROUND
  The U.S. Preventive Services Task Force recently concluded that the harms of existing prostate-specific antigen (PSA) screening strategies outweigh the benefits.
  
  
  OBJECTIVE
  To evaluate comparative effectiveness of alternative PSA screening strategies.
  
  
  METHODS
  Microsimulation model of prostate cancer incidence and mortality quantifying harms and lives saved for alternative PSA screening strategies.
  
  
  METHODS
  National and trial data on PSA growth, screening and biopsy patterns, incidence, treatment distributions, treatment efficacy, and mortality.
  
  
  METHODS
  A contemporary cohort of U.S. men.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  35 screening strategies that vary by start and stop ages, screening intervals, and thresholds for biopsy referral.
  
  
  METHODS
  PSA tests, false-positive test results, cancer detected, overdiagnoses, prostate cancer deaths, lives saved, and months of life saved.
  
  
  RESULTS
  Without screening, the risk for prostate cancer death is 2.86%. A reference strategy that screens men aged 50 to 74 years annually with a PSA threshold for biopsy referral of 4 µg/L reduces the risk for prostate cancer death to 2.15%, with risk for overdiagnosis of 3.3%. A strategy that uses higher PSA thresholds for biopsy referral in older men achieves a similar risk for prostate cancer death (2.23%) but reduces the risk for overdiagnosis to 2.3%. A strategy that screens biennially with longer screening intervals for men with low PSA levels achieves similar risks for prostate cancer death (2.27%) and overdiagnosis (2.4%), but reduces total tests by 59% and false-positive results by 50%.
  
  
  RESULTS
  Varying incidence inputs or reducing the survival improvement due to screening did not change conclusions.
  
  
  CONCLUSIONS
  The model is a simplification of the natural history of prostate cancer, and improvement in survival due to screening is uncertain.
  
  
  CONCLUSIONS
  Compared with standard screening, PSA screening strategies that use higher thresholds for biopsy referral for older men and that screen men with low PSA levels less frequently can reduce harms while preserving lives.
  
  
  BACKGROUND
  National Cancer Institute and Centers for Disease Control and Prevention.
authors: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M2-B230, PO Box 19024, Seattle, WA 98109-1024, USA.
authors: Roman
authors: R
authors: Gulati
authors: John L
authors: JL
authors: Gore
authors: Ruth
authors: R
authors: Etzioni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D057186:Comparative Effectiveness Research; D003198:Computer Simulation; D055088:Early Detection of Cancer / Q000379:methods*; D005189:False Positive Reactions; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D018570:Risk Assessment; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen
references: Biostatistics. 2010 Oct;11(4):707-19
references: 20530126
references: Cancer. 2010 Nov 15;116(22):5226-34
references: 20690197
references: J Clin Oncol. 2011 Feb 1;29(4):355-61
references: 21041707
references: Med Decis Making. 2011 Jul-Aug;31(4):550-8
references: 21406620
references: Annu Rev Public Health. 2010;31:439-55
references: 20235853
references: J Clin Epidemiol. 2011 Dec;64(12):1412-7
references: 22032753
references: J Urol. 2000 Jan;163(1):152-7
references: 10604335
references: J Urol. 2005 Mar;173(3):746-50; discussion 750-1
references: 15711261
references: Ann Intern Med. 2008 Nov 4;149(9):659-69
references: 18838717
references: Cancer Causes Control. 2012 Jun;23(6):827-35
references: 22488488
references: Ann Intern Med. 2012 Jul 17;157(2):120-34
references: 22801674
references: J Urol. 2000 Jan;163(1):163-6; discussion 166-7
references: 10604337
references: CA Cancer J Clin. 2010 Mar-Apr;60(2):70-98
references: 20200110
references: JAMA. 1993 Aug 18;270(7):860-4
references: 7688054
references: N Engl J Med. 2009 Mar 26;360(13):1310-9
references: 19297565
references: Ann Intern Med. 2006 Mar 21;144(6):441-3
references: 16549857
references: Cancer. 2012 Dec 1;118(23):5955-63
references: 22605665
references: J Natl Compr Canc Netw. 2010 Feb;8(2):240-62
references: 20141680
references: Cancer. 2007 May 1;109(9):1877-86
references: 17372918
references: J Natl Cancer Inst. 2012 Jan 18;104(2):125-32
references: 22228146
references: N Engl J Med. 2012 Aug 16;367(7):669-71
references: 22894580
references: J Natl Cancer Inst. 2006 Apr 19;98(8):529-34
references: 16622122
references: N Engl J Med. 2009 Mar 26;360(13):1320-8
references: 19297566
references: J Urol. 2001 May;165(5):1554-9
references: 11342916
references: JAMA. 1997 May 14;277(18):1456-60
references: 9145718
references: Stat Med. 2006 Aug 30;25(16):2846-66
references: 16397859
references: Value Health. 2001 Sep-Oct;4(5):348-61
references: 11705125
references: JAMA. 2011 Dec 28;306(24):2649-50
references: 22203530
references: Eur Urol. 2012 May;61(5):1011-8
references: 22264679
references: Ann Intern Med. 2009 Nov 17;151(10):738-47
references: 19920274
references: J Natl Cancer Inst. 2003 Jun 18;95(12):868-78
references: 12813170
references: J Urol. 2006 May;175(5):1605-12
references: 16600713
references: N Engl J Med. 2011 May 5;364(18):1708-17
references: 21542742
references: N Engl J Med. 2012 Aug 16;367(7):595-605
references: 22894572
references: Nat Rev Urol. 2009 Jun;6(6):301-3
references: 19498406
references: Ann Intern Med. 2006 Mar 21;144(6):438-40
references: 16549856
references: N Engl J Med. 2012 Mar 15;366(11):981-90
references: 22417251
references: Nat Rev Urol. 2012 Mar 13;9(4):183-5
references: 22410678
references: BJU Int. 2003 Dec;92 Suppl 2:97-100
references: 14983964
references: J Clin Oncol. 2011 Feb 1;29(4):464-7
references: 21189374