title: Estimating the individual benefit of immediate treatment or active surveillance for prostate cancer after screen-detection in older (65+) men.
abstract: A significant proportion of screen-detected men with prostate cancer is likely to be overtreated, especially in older age groups. We aim to find which groups of screen-detected older men (65+) benefit the most from Immediate Radical Treatment or Active Surveillance (AS) for prostate cancer, depending on age, screening history, health status and prostate cancer stage at detection. We used a microsimulation model (MISCAN) of the natural history of prostate cancer based on ERSPC data. Individual life histories are simulated with US comorbidity lifetables based on a random sample of MEDICARE data. Different screening histories are simulated and we count outcomes for men screen-detected from ages 66 to 72. For immediately treated men with low-risk disease (≤ T2a, Gleason 6) the probability of overtreatment ranges from 61% to 86% decreasing to between 37 and 46%, if they are assigned to AS. For intermediate risk men (≤ T2, Gleason 3 + 4) overtreatment ranges from 23 to 60%, which reduces to between 16 and 31% for AS. For high risk men (T3, or ≥ Gleason 4 + 3), overtreatment ranges from 11 to 51%. The disease stage at screen-detection is a critical risk factor for overtreatment. For low risk men, AS seems to significantly reduce overtreatment at a modest cost. For intermediate risk men, the decision between immediate treatment or AS depends on age and comorbidity status. Men screen-detected in a high risk disease stage may benefit from immediate treatment even beyond age 69.
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Tiago M
authors.initials: TM
authors.lastname: de Carvalho
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Eveline A M
authors.initials: EA
authors.lastname: Heijnsdijk
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003198:Computer Simulation; D018450:Disease Progression; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D015233:Models, Statistical; D060787:Neoplasm Grading; D017063:Outcome Assessment, Health Care; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D047368:Tumor Burden; D057832:Watchful Waiting
keywords: comorbidity; microsimulation model; overtreatment; prostate cancer screening