Abstract
BackgroundProstate cancer screening incurs a high risk of overdiagnosis and overtreatment. An organized and age‐targeted screening strategy may reduce the associated harms while retaining or enhancing the benefits.MethodsUsing a micro‐simulation analysis (MISCAN) model, we assessed the harms, benefits, and cost‐effectiveness of 230 prostate‐specific antigen (PSA) screening strategies in a Dutch population. Screening strategies were varied by screening start age (50, 51, 52, 53, 54, and 55), stop age (51‐69), and intervals (1, 2, 3, 4, 8, and single test). Costs and effects of each screening strategy were compared with a no‐screening scenario.ResultsThe most optimum strategy would be screening with 3‐year intervals at ages 55–64 resulting in an incremental cost‐effectiveness ratio (ICER) of €19 733 per QALY. This strategy predicted a 27% prostate cancer mortality reduction and 28 life years gained (LYG) per 1000 men; 36% of screen‐detected men were overdiagnosed. Sensitivity analyses did not substantially alter the optimal screening strategy.ConclusionsPSA screening beyond age 64 is not cost‐effective and associated with a higher risk of overdiagnosis. Similarly, starting screening before age 55 is not a favored strategy based on our cost‐effectiveness analysis.
Highlights
Prostate cancer screening incurs a high risk of overdiagnosis and overtreatment
According to the model predictions, the highest quality-adjusted life years (QALY) were estimated for age 62 in a one-time screening strategy; extending once only screening to age 69 resulted in a loss in QALYs
This study shows that screening strategies with intervals of 4 years or shorter were more efficient than strategies with longer intervals
Summary
The incidence of prostate cancer has increased in most European countries, whereas prostate cancer mortality rates have declined.[1,2] Most Western European countries have experienced a sharp rise in the incidence of prostate cancer. The 18-year follow-up study from the Goteborg randomized control trial, one center of the ERSPC trial, showed a large and statistically significant relative prostate cancer mortality reduction (RR = 0.31) for the attendees in this age group.[8] two other recent studies indicated a possible benefit of screening for this age group.[12,13] the overall result reported from the CAP (Cluster Randomized Trial of PSA Testing for Prostate Cancer) trial was insignificant, the highest prostate cancer mortality reduction was seen in this age group.[13] The insignificant result from the CAP trial may be related to the single screening offered and its lower acceptance rate (36%).[14]. A total of 230 screening strategies were evaluated using a micro-simulation analysis model
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