title: Treatment of local-regional prostate cancer detected by PSA screening: benefits and harms according to prognostic factors.
abstract: BACKGROUND
  Men with screen-detected prostate cancer can choose to undergo immediate curative treatment or enter into an expectant management programme. We quantified how the benefits and harms of immediate treatment vary according to the prognostic factors of clinical T-stage, Gleason score, and patient age.
  
  
  METHODS
  A microsimulation model based on European Randomized Study of Screening for Prostate Cancer data was used to predict the benefits and harms of immediate treatment versus delayed treatment of local-regional prostate cancer in men aged 55-74 years. Benefits included life-years gained and reduced probability of death from prostate cancer. Harms included lead time and probability of overdiagnosis.
  
  
  RESULTS
  The ratio of mean lead time to mean life-years gained ranged from 1.8 to 31.2, and the additional number of treatments required per prostate cancer death prevented ranged from 0.3 to 11.6 across the different prognostic groups. Both harm-benefit ratios were lowest, most favourable, for men aged 55-59 years and diagnosed with moderate-risk prostate cancer. Ratios were high for men aged 70-74 years regardless of clinical T-stage and Gleason score.
  
  
  CONCLUSIONS
  Men aged 55-59 years with moderate-risk prostate cancer are predicted to derive greatest benefit from immediate curative treatment. Immediate treatment is least favourable for men aged 70-74 years with either low-risk or high-risk prostate cancer.
authors.affiliation: Department of Public Health, Erasmus Medical Center, P.O. Box 2040, Rotterdam, 3000, CA, The Netherlands. e.m.wever@erasmusmc.nl
authors.forename: E M
authors.initials: EM
authors.lastname: Wever
authors.forename: E A M
authors.initials: EA
authors.lastname: Heijnsdijk
authors.forename: G
authors.initials: G
authors.lastname: Draisma
authors.forename: C H
authors.initials: CH
authors.lastname: Bangma
authors.forename: M J
authors.initials: MJ
authors.lastname: Roobol
authors.forename: F H
authors.initials: FH
authors.lastname: Schröder
authors.forename: H J
authors.initials: HJ
authors.lastname: de Koning
mesh_terms: D000368:Aged; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D008136:Longevity / Q000502:physiology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000032:analysis / Q000097:blood*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D017430:Prostate-Specific Antigen