Expected population impacts of discontinued prostate-specific antigen screening

Roman Gulati, Alex Tsodikov, Ruth Etzioni, Rachel A. Hunter-Merrill, John L. Gore, Angela B. Mariotto, Matthew R. Cooperberg

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

BACKGROUND: Prostate-specific antigen (PSA) screening for prostate cancer has high risks of overdiagnosis, particularly among older men, and reports from screening trials indicate that it saves few lives after 11 to 13 years of follow-up. New clinical guidelines recommend against PSA screening for all men or for men aged >70 years, but, to the authors' knowledge, the expected population effects of these guidelines have not been studied to date. METHODS: Two models of prostate cancer natural history and diagnosis were previously developed using reconstructed PSA screening patterns and prostate cancer incidence in the United States. Assuming a survival benefit of PSA screening consistent with the screening trials, the authors used the models to predict incidence and mortality rates for the period from 2013 through 2025 under continued PSA screening and under discontinued PSA screening for all men or for men aged >70 years. RESULTS: The models predicted that continuation of recent screening rates will overdiagnose 710,000 to 1,120,000 men (range between models) but will avoid 36,000 to 57,000 cancer deaths over the period 2013 through 2025. Discontinued screening for all men eliminated 100% of overdiagnoses but failed to prevent 100% of avoidable cancer deaths. Continued screening for men aged <70 years eliminated 64% to 66% of overdiagnoses but failed to prevent 36% to 39% of avoidable cancer deaths. CONCLUSIONS: Discontinuing PSA screening for all men may generate many avoidable cancer deaths. Continuing PSA screening for men aged <70 years could prevent greater than one-half of these avoidable cancer deaths while dramatically reducing overdiagnoses compared with continued PSA screening for all ages. Cancer 2014;120:3519–3526.

Original languageEnglish (US)
Pages (from-to)3519-3526
Number of pages8
JournalCancer
Volume120
Issue number22
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

Fingerprint

Prostate-Specific Antigen
Population
Neoplasms
Prostatic Neoplasms
Guidelines
Incidence
Natural History
Medical Overuse
Survival
Mortality

Keywords

  • mass screening
  • models
  • prostate-specific antigen
  • prostatic neoplasms
  • statistical
  • surveillance

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Gulati, R., Tsodikov, A., Etzioni, R., Hunter-Merrill, R. A., Gore, J. L., Mariotto, A. B., & Cooperberg, M. R. (2014). Expected population impacts of discontinued prostate-specific antigen screening. Cancer, 120(22), 3519-3526. https://doi.org/10.1002/cncr.28932

Expected population impacts of discontinued prostate-specific antigen screening. / Gulati, Roman; Tsodikov, Alex; Etzioni, Ruth; Hunter-Merrill, Rachel A.; Gore, John L.; Mariotto, Angela B.; Cooperberg, Matthew R.

In: Cancer, Vol. 120, No. 22, 01.11.2014, p. 3519-3526.

Research output: Contribution to journalArticle

Gulati, R, Tsodikov, A, Etzioni, R, Hunter-Merrill, RA, Gore, JL, Mariotto, AB & Cooperberg, MR 2014, 'Expected population impacts of discontinued prostate-specific antigen screening', Cancer, vol. 120, no. 22, pp. 3519-3526. https://doi.org/10.1002/cncr.28932
Gulati R, Tsodikov A, Etzioni R, Hunter-Merrill RA, Gore JL, Mariotto AB et al. Expected population impacts of discontinued prostate-specific antigen screening. Cancer. 2014 Nov 1;120(22):3519-3526. https://doi.org/10.1002/cncr.28932
Gulati, Roman ; Tsodikov, Alex ; Etzioni, Ruth ; Hunter-Merrill, Rachel A. ; Gore, John L. ; Mariotto, Angela B. ; Cooperberg, Matthew R. / Expected population impacts of discontinued prostate-specific antigen screening. In: Cancer. 2014 ; Vol. 120, No. 22. pp. 3519-3526.
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abstract = "BACKGROUND: Prostate-specific antigen (PSA) screening for prostate cancer has high risks of overdiagnosis, particularly among older men, and reports from screening trials indicate that it saves few lives after 11 to 13 years of follow-up. New clinical guidelines recommend against PSA screening for all men or for men aged >70 years, but, to the authors' knowledge, the expected population effects of these guidelines have not been studied to date. METHODS: Two models of prostate cancer natural history and diagnosis were previously developed using reconstructed PSA screening patterns and prostate cancer incidence in the United States. Assuming a survival benefit of PSA screening consistent with the screening trials, the authors used the models to predict incidence and mortality rates for the period from 2013 through 2025 under continued PSA screening and under discontinued PSA screening for all men or for men aged >70 years. RESULTS: The models predicted that continuation of recent screening rates will overdiagnose 710,000 to 1,120,000 men (range between models) but will avoid 36,000 to 57,000 cancer deaths over the period 2013 through 2025. Discontinued screening for all men eliminated 100{\%} of overdiagnoses but failed to prevent 100{\%} of avoidable cancer deaths. Continued screening for men aged <70 years eliminated 64{\%} to 66{\%} of overdiagnoses but failed to prevent 36{\%} to 39{\%} of avoidable cancer deaths. CONCLUSIONS: Discontinuing PSA screening for all men may generate many avoidable cancer deaths. Continuing PSA screening for men aged <70 years could prevent greater than one-half of these avoidable cancer deaths while dramatically reducing overdiagnoses compared with continued PSA screening for all ages. Cancer 2014;120:3519–3526.",
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AU - Mariotto, Angela B.

AU - Cooperberg, Matthew R.

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N2 - BACKGROUND: Prostate-specific antigen (PSA) screening for prostate cancer has high risks of overdiagnosis, particularly among older men, and reports from screening trials indicate that it saves few lives after 11 to 13 years of follow-up. New clinical guidelines recommend against PSA screening for all men or for men aged >70 years, but, to the authors' knowledge, the expected population effects of these guidelines have not been studied to date. METHODS: Two models of prostate cancer natural history and diagnosis were previously developed using reconstructed PSA screening patterns and prostate cancer incidence in the United States. Assuming a survival benefit of PSA screening consistent with the screening trials, the authors used the models to predict incidence and mortality rates for the period from 2013 through 2025 under continued PSA screening and under discontinued PSA screening for all men or for men aged >70 years. RESULTS: The models predicted that continuation of recent screening rates will overdiagnose 710,000 to 1,120,000 men (range between models) but will avoid 36,000 to 57,000 cancer deaths over the period 2013 through 2025. Discontinued screening for all men eliminated 100% of overdiagnoses but failed to prevent 100% of avoidable cancer deaths. Continued screening for men aged <70 years eliminated 64% to 66% of overdiagnoses but failed to prevent 36% to 39% of avoidable cancer deaths. CONCLUSIONS: Discontinuing PSA screening for all men may generate many avoidable cancer deaths. Continuing PSA screening for men aged <70 years could prevent greater than one-half of these avoidable cancer deaths while dramatically reducing overdiagnoses compared with continued PSA screening for all ages. Cancer 2014;120:3519–3526.

AB - BACKGROUND: Prostate-specific antigen (PSA) screening for prostate cancer has high risks of overdiagnosis, particularly among older men, and reports from screening trials indicate that it saves few lives after 11 to 13 years of follow-up. New clinical guidelines recommend against PSA screening for all men or for men aged >70 years, but, to the authors' knowledge, the expected population effects of these guidelines have not been studied to date. METHODS: Two models of prostate cancer natural history and diagnosis were previously developed using reconstructed PSA screening patterns and prostate cancer incidence in the United States. Assuming a survival benefit of PSA screening consistent with the screening trials, the authors used the models to predict incidence and mortality rates for the period from 2013 through 2025 under continued PSA screening and under discontinued PSA screening for all men or for men aged >70 years. RESULTS: The models predicted that continuation of recent screening rates will overdiagnose 710,000 to 1,120,000 men (range between models) but will avoid 36,000 to 57,000 cancer deaths over the period 2013 through 2025. Discontinued screening for all men eliminated 100% of overdiagnoses but failed to prevent 100% of avoidable cancer deaths. Continued screening for men aged <70 years eliminated 64% to 66% of overdiagnoses but failed to prevent 36% to 39% of avoidable cancer deaths. CONCLUSIONS: Discontinuing PSA screening for all men may generate many avoidable cancer deaths. Continuing PSA screening for men aged <70 years could prevent greater than one-half of these avoidable cancer deaths while dramatically reducing overdiagnoses compared with continued PSA screening for all ages. Cancer 2014;120:3519–3526.

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