Comparative Efficiency of Prostate-Specific Antigen Screening Strategies for Prostate Cancer Detection

Ross, Kevin S.

doi:10.1001/jama.284.11.1399

Cited by 134 publications

(73 citation statements)

References 26 publications

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“…In our own screening collective around two-thirds of all men had thus a low risk and could be seen at longer intervals. The Ross and colleagues working group were able to show that by adopting such an approach not only could costs be cut but mortality could also be reduced compared with early detection as from 50 years (13). Reduced mortality is attributable, first, to the fact that on comparing younger men with those over 50 years, the younger men have a higher probability of having a curable form of prostate cancer (14,15).…”

Section: Discussionmentioning

confidence: 99%

PSA Quo Vadis? It Is Reasonable to Start with Prostate-Specific Antigen Testing at the Age of 40!

Börgermann

Dorp

Swoboda

et al. 2011

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: It is common to start with PSA (prostate-specific antigen)-testing at the age of 50. If patients with a PSA value greater than 4 ng/mL should be considered for prostate biopsy, approximately 20% of all men undergoing test are considered for biopsy at the time of first early-detection examination.Methods: We have screened 2,592 asymptomatic men younger than 45 years. With a short questionnaire, we assessed age, body mass index (BMI), concomitant diseases, last sexual intercourse, and last bicycle riding. We compared this cohort with a group of 11,656 men aged 45-75 years from a nationwide prostate cancer screening trial.Results: In this cohort, only 4 men with a PSA value greater than 4 ng/mL and 10 with a PSA greater than 3 ng/mL were identified. More than 99% of all men younger than 45 years had a PSA lesser than 4 ng/mL. Sexual intercourse, bicycle riding, or BMI had a significant but minimal influence on the PSA value.Conclusions: It is reasonable to start with PSA testing at the age of 40 years. The advantage of screening younger patients is that almost no one should be considered for biopsy at the time of first early-detection examination. We identified a baseline value at which only a minimal influence was exerted by benign prostatic hypertrophy. In comparison with many current guidelines, we gained a lead time of 10 years for observation of PSA dynamics.Impact: The importance of PSA velocity for stratification of patients at risk for development of significant prostate cancer will grow. Cancer Epidemiol Biomarkers Prev; 20(6); 1190-5. Ó2011 AACR.

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Section: Discussionmentioning

confidence: 99%

PSA Quo Vadis? It Is Reasonable to Start with Prostate-Specific Antigen Testing at the Age of 40!

Börgermann

Dorp

Swoboda

et al. 2011

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Short intervals increase drawbacks, such as overdiagnosis and costs of screening without necessarily improving efficacy in terms of advanced cancers prevented, whereas too long an interval is likely to miss potentially lethal tumors at curable stages. Both observational and simulation studies have recently suggested the alternative of biannual instead of annual screening with a minimal risk of nonlocalized cancer (17,18). Nonrandomized studies and modeling are, however, prone to several biases.…”

Section: Discussionmentioning

confidence: 99%

Second Round Results of the Finnish Population-Based Prostate Cancer Screening Trial

Mäkinen

Tammela

Stenman

et al. 2004

Clinical Cancer Research

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Purpose: Large randomized trials provide the only valid means of quantifying the benefits and drawbacks of prostatespecific antigen (PSA) screening, but the follow-up of ongoing studies is still too short to allow evaluation of mortality. We report here the intermediate indicators of screening efficacy from the second round of the Finnish trial.Experimental Design: The Finnish trial, with ϳ80,000 men in the target population, is the largest component in the European Randomized Study of Screening for Prostate Cancer. The first round was completed in 1996 -1999. Each year 8,000 men 55-67 years of age were randomly assigned to the screening arm, and the rest formed the control arm. Men randomized to the screening arm in 1996 were reinvited 4 years later, in 2000, and PSA was determined.Results: Of the eligible 6415 men, 4407 (69%) eventually participated in the second round of screening. Of the first-round participants, up to 84% (3833 of 4556) attended rescreening. A total of 461 screenees (10.5%) had PSA levels of >4 g/liter. Altogether, 97 cancers were found, yielding an overall detection rate of 2.2% (97 of 4407). Seventy-nine cases were found among the 3833 second-time screenees (detection rate 2.1%) and 18 in those 574 men (3.1%) who had not participated previously. A PSA of >4 g/liter, but negative biopsy in the first screening round was associated with an up to 9-fold risk of cancer in rescreening relative to those with lower PSA levels at baseline. Ninety-one (94%) of all of the detected cancers were clinically localized.Conclusions: As surrogate measures of an effective screening program, both compliance as well as the overall and advanced prostate cancer detection rates remained acceptable. Men defined as screen-positive but with a negative confirmation of cancer at prevalence screen formed a highrisk group at rescreening.

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“…Ross et al (2000) report on a simulation model to compare simple strategies (e.g. no screening, and screening intervals of 1, 2, and 5 yrs) based on performance measures including the number of PSA tests per 1000 men and prostate cancer deaths prevented.…”

Section: Introductionmentioning

confidence: 99%

Optimization of Prostate Biopsy Referral Decisions

Zhang

Denton

Balasubramanian

et al. 2012

M&SOM

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Prostate cancer is the most common solid tumor in American men and is screened for using prostate-specific antigen (PSA) tests. We report on a non-stationary partially observable Markov decision process (POMDP) for prostate biopsy referral decisions. The core states are the patients' prostate cancer related health states, and PSA test results are the observations. Transition probabilities and rewards are inferred from the Mayo Clinic Radical Prostatectomy Registry (MCRPR) and the medical literature. The objective of our model is to maximize expected quality-adjusted life years (QALYs). We solve the POMDP model to obtain an age and belief (probability of having prostate cancer) dependent optimal biopsy referral policy. We also prove a number of structural properties including the existence of a control-limit type policy for the biopsy referral decision. Our empirical results demonstrate a non-decreasing belief threshold in age, and we provide sufficient conditions under which PSA screening should be discontinued for older patients. Finally, the benefits of screening under the optimal biopsy referral policy are estimated, and sensitivity analysis is used to prioritize the model parameters that would benefit from additional data collection.

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Comparative Efficiency of Prostate-Specific Antigen Screening Strategies for Prostate Cancer Detection

Cited by 134 publications

References 26 publications

PSA Quo Vadis? It Is Reasonable to Start with Prostate-Specific Antigen Testing at the Age of 40!

PSA Quo Vadis? It Is Reasonable to Start with Prostate-Specific Antigen Testing at the Age of 40!

Second Round Results of the Finnish Population-Based Prostate Cancer Screening Trial

Optimization of Prostate Biopsy Referral Decisions

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