Journal
CANCER EPIDEMIOLOGY
Volume 46, Issue -, Pages 14-19Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.canep.2016.11.005
Keywords
Longitudinal PSA model; Prostate cancer; Prostate-specific antigen; Screening; Simulation model
Funding
- Academy of Finland [260931]
- Competitive Research Fund (Pirkanmaa Hospital District)
- Finnish Cancer Organizations
- National Technology Agency (TEKES), Finland
- National Cancer Institute [01CA160816, P50CA92629, P30CA008748]
- Prostate Cancer Foundation at MSKCC
- New York, NY, USA
- Swedish Cancer Society [11-0624]
- Fundacion Federico SA
- National Institute for Health Research (NIHR)
- AFA Insurance
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Background: The European Randomised study of Screening for Prostate Cancer (ERSPC) is a multicentre, randomised screening trial on men aged 55-69 years at baseline without known prostate cancer (PrCa) at randomisation to an intervention arm invited to screening or to a control arm. The ERSPC has shown a significant 21% reduction in PrCa mortality at 13 years of follow-up. The effect of screening appears to vary across centres, for which several explanations are possible. We set to assess if the apparent differences in PrCa mortality reduction between the centres can be explained by differences in screening protocols. Methods: We examined the centre differences by developing a simulation model and estimated how alternative screening protocols would have affected PrCa mortality. Results: Our results showed outcomes similar to those observed, when the results by centres were reproduced by simulating the screening regimens with PSA threshold of 3 versus 4 ng/ml, or screening interval of two versus four years. The findings suggest that the differences are only marginally attributable to the different screening protocols. Conclusion: The small screening impact in Finland was not explained by the differences in the screening protocols. A possible reason for it was the contamination of and the unexpectedly low PrCa mortality in the Finnish control arm. (C) 2016 Elsevier Ltd. All rights reserved.
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