You have accessJournal of UrologyProstate Cancer: Detection and Screening II1 Apr 20121450 THE TRUE BENEFIT OF PSA-SCREENING: MODELING THE IMPACT OF TRIAL SETTING AND PROTOCOL ON MORTALITY Eveline Heijnsdijk, Elisabeth Wever, and Harry de Koning Eveline HeijnsdijkEveline Heijnsdijk Rotterdam, Netherlands More articles by this author , Elisabeth WeverElisabeth Wever Rotterdam, Netherlands More articles by this author , and Harry de KoningHarry de Koning Rotterdam, Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1944AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The ERSPC trial showed a significant prostate cancer mortality reduction for the PSA-screening arm, while the PLCO trial didn't. A number of explanations caused by differences in the trials have been debated, such as contamination in the control arm, differences in compliance after referral to biopsy and screening interval. Still, in meta-analyses, the results of both trials are often, incorrectly, just simply pooled. By modeling, we will show the impact of the trial setting and protocol, to assess the impact of these differences on mortality and to evaluate whether the results of the trials are really contradictory. METHODS Using a micro-simulation modeling calibrated on data of the ERSPC trial, we estimated the cure rate of screen detected cancers leading to a 27% mortality reduction for men screened at least once. We used this cure rate in a model calibrated on published data of the PLCO trial. Using this PLCO model, we predicted what the prostate cancer mortality reduction in the PLCO trial would have been when there was no screening in the control arm. Then, we changed the assumptions for the PLCO trial, by increasing the biopsy compliance to 100%, the screening attendance to 100%, including screening in the control arm and increasing the screening interval to 4 years. RESULTS In the absence of screening in the control arm, the predicted prostate cancer mortality reduction in the PLCO trial is 23%. Using a screening attendance rate of 100%, the mortality reduction would be 25%, and using a biopsy compliance rate of 100% the mortality reduction would be 41%. Including screening in the control arm leads to a mortality reduction of 14% and a 4 year interval to 11%. CONCLUSIONS Differences in biopsy compliance and screening in the control arm between the two trials can explain a large part of the difference in the outcome of the trials. The mortality reductions will also be predicted by two other models of the Cancer Intervention and Surveillance Modeling Network (CISNET) to quantify more robust the contribution of the trial setting and protocol to the mortality reduction. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e588 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eveline Heijnsdijk Rotterdam, Netherlands More articles by this author Elisabeth Wever Rotterdam, Netherlands More articles by this author Harry de Koning Rotterdam, Netherlands More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...