title: Estimating the harms and benefits of prostate cancer screening as used in common practice versus recommended good practice: A microsimulation screening analysis.
abstract: BACKGROUND
  Prostate-specific antigen (PSA) screening and concomitant treatment can be implemented in several ways. The authors investigated how the net benefit of PSA screening varies between common practice versus "good practice."
  
  
  METHODS
  Microsimulation screening analysis (MISCAN) was used to evaluate the effect on quality-adjusted life-years (QALYs) if 4 recommendations were followed: limited screening in older men, selective biopsy in men with elevated PSA, active surveillance for low-risk tumors, and treatment preferentially delivered at high-volume centers. Outcomes were compared with a base model in which annual screening started at ages 55 to 69 years and were simulated using data from the European Randomized Study of Screening for Prostate Cancer.
  
  
  RESULTS
  In terms of QALYs gained compared with no screening, for 1000 screened men who were followed over their lifetime, recommended good practice led to 73 life-years (LYs) and 74 QALYs gained compared with 73 LYs and 56 QALYs for the base model. In contrast, common practice led to 78 LYs gained but only 19 QALYs gained, for a greater than 75% relative reduction in QALYs gained from unadjusted LYs gained. The poor outcomes for common practice were influenced predominantly by the use of aggressive treatment for men with low-risk disease, and PSA testing in older men also strongly reduced potential QALY gains.
  
  
  CONCLUSIONS
  Commonly used PSA screening and treatment practices are associated with little net benefit. Following a few straightforward clinical recommendations, particularly greater use of active surveillance for low-risk disease and reducing screening in older men, would lead to an almost 4-fold increase in the net benefit of prostate cancer screening. Cancer 2016;122:3386-3393. © 2016 American Cancer Society.
authors.affiliation: Deptartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. carlssos@mskcc.org.|Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York. carlssos@mskcc.org.|Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. carlssos@mskcc.org.
authors.forename: Sigrid V
authors.initials: SV
authors.lastname: Carlsson
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 Urology, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Monique J
authors.initials: MJ
authors.lastname: Roobol
authors.affiliation: Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.|Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
authors.affiliation: School of Health Sciences, Tampere University, Tampere, Finland.
authors.forename: Anssi
authors.initials: A
authors.lastname: Auvinen
authors.affiliation: Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland.|Department of Urology, Academic Hospital Braunschweig, Brunswick, Germany.
authors.forename: Maciej
authors.initials: M
authors.lastname: Kwiatkowski
authors.affiliation: Department of Urology, Lille University Hospital, University of Lille Nord de France, Lille, France.
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
authors.affiliation: Unit of Clinical and Descriptive Epidemiology, Institute for Cancer Research and Prevention-ISPO, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
authors.affiliation: Provincial Institute for Hygiene, Antwerp, Belgium.
authors.forename: Vera
authors.initials: V
authors.lastname: Nelen
authors.affiliation: Department of Urology, Fuenlabrada University Hospital, Madrid, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Páez
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.|Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.|Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.|Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.|Department of Translational Medicine, Lund University, Malmo, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Lilja
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Vickers
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Eveline A M
authors.initials: EA
authors.lastname: Heijnsdijk
mesh_terms: D000368:Aged; D003198:Computer Simulation; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic / Q000592:standards*; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic
chemical_list: D017430:Prostate-Specific Antigen
keywords: early detection of cancer/adverse effects; mass screening; prostate-specific antigen/blood; prostatic neoplasms; quality of life; quality-adjusted-life-years