Benefits of screening for PSA offset by reduced quality of life
After 11 years of follow-up, the European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a 29% reduction in prostate cancer mortality among men who underwent screening for prostate-specific antigen (PSA) levels. However, the extent to which harms to quality of life resulting from over-diagnosis and treatment counterbalance this benefit is uncertain.
On the basis of ERSPC follow-up data, we used Microsimulation
Screening Analysis (MISCAN) to predict the number of prostate
cancers, treatments, deaths and quality-adjusted life years
(QALYs) gained after the introduction of PSA screening. Various
screening strategies, efficacies and quality-of-life assum
ptions were modelled.
It was predicted that, per 1 000 men of all ages followed for their entire lives, annual screening of men between the ages of 55 and 69 years would result in 9 fewer deaths from prostate cancer (28% reduction), 14 fewer men receiving palliative therapy (35% reduction), and a total of 73 life years gained (average 8.4 years per prostate cancer death avoided). The number of QALYs that were gained was 56 (range 21 - 97), a reduction of 23% from unadjusted life years gained. To prevent one prostate cancer death, 98 men would need to be screened and 5 cancers would need to be detected. Screening of all men between the ages of 55 and 74 would result in more life years gained (82) but the same number of QALYs (56).
The benefit of PSA screening was diminished by loss of QALYs owing to post-diagnosis long-term effects. Longer follow-up data from both the ERSPC and quality-of-life analyses are essential before universal recommendations regarding screening can be made.
Heijnsdijk EAM, et al. N Engl J Med 2012;367:595-605.
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