期刊
JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE
卷 107, 期 1, 页码 -出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/jnci/dju366
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资金
- Netherlands Organisation for Health Research and Development [ZonMW 002822820, 22000106, 50-50110-98-311]
- Dutch Cancer Society [KWF 94-869, 98-1657, 2002-277, 2006-3518]
- Europe Against Cancer
- fifth and sixth framework program of the European Union
- Beckman Coulter
- Dutch Cancer Society, The Netherlands [KWF 94-869, 98-1657, 2002-277, 2006-3518]
- Netherlands Organisation for Health Research and Development, The Netherlands [ZonMW 002822820, 22000106, 50-50110-98-311]
- Europe against Cancer, Belgium
- Flemish Ministry of Welfare, Belgium
- Public Health and Family, Belgium
- Province and City of Antwerp, Belgium
- Public Centre for Social Welfare Antwerp, Belgium
- Abbott Pharmaceuticals, Sweden
- Af Jochnick's Foundation, Sweden
- Catarina and Sven Hagstroms Family Foundation, Sweden
- Gunvor and Ivan Svensson's Foundation, Sweden
- Johanniterorden, Sweden
- King Gustav V Jubilee Clinic Cancer Research Foundation, Sweden
- Sahlgrenska University Hospital, Sweden
- Schering Plough, Sweden
- Swedish Cancer Society, Sweden
- Wallac Oy, Sweden
- Turku, Finland, Sweden
- Academy of Finland, Finland [123054, 260931]
- Cancer Society of Finland, Finland
- Competitive Research Funding of the Pirkanmaa Hospital District, Finland
- Perkin Elmer-Wallac, Finland
- Italian League for the Fight aganist Cancer (LILT Lega Italiana per la Lotta contro i Tumori), Italy
- Italian Association for Cancer Research (AIRC Associazione Italiana Ricerca sul Cancro), Italy
- National Research Council (CNR Consiglio Nazionale delle Ricerche Tuscany), Italy
- Region (Regione Toscana), Italy
- Spanish Fondo de Investigacion Sanitaria (FIS), Spain [96/0248, 99/0245, 02/0732, 06/0831]
- Horten Foundation, Switzerland
- Aargau Cancer League, Switzerland
- Swiss Cancer League, Switzerland [KFS 787-2-1999, 01112-02-2001]
- Health Department of Canton Aargau, Switzerland
- Prostate Cancer Research Foundation, Switzerland
- Baugarten Foundation, Switzerland
- Messerli Foundation, Switzerland
- European Union [SOC 95 35109, SOC 96 201869 05F022, SOC 97 201329, SOC 98 32241]
- 6th Framework Program of the EU: PMark [LSHC-CT-2004-503011]
- Beckman-Coulter-Hybritech, Inc.
The results of the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial showed a statistically significant 29% prostate cancer mortality reduction for the men screened in the intervention arm and a 23% negative impact on the life-years gained because of quality of life. However, alternative prostate-specific antigen (PSA) screening strategies for the population may exist, optimizing the effects on mortality reduction, quality of life, overdiagnosis, and costs. Based on data of the ERSPC trial, we predicted the numbers of prostate cancers diagnosed, prostate cancer deaths averted, life-years and quality-adjusted life-years (QALY) gained, and cost-effectiveness of 68 screening strategies starting at age 55 years, with a PSA threshold of 3, using microsimulation modeling. The screening strategies varied by age to stop screening and screening interval (one to 14 years or once in a lifetime screens), and therefore number of tests. Screening at short intervals of three years or less was more cost-effective than using longer intervals. Screening at ages 55 to 59 years with two-year intervals had an incremental cost-effectiveness ratio of $73000 per QALY gained and was considered optimal. With this strategy, lifetime prostate cancer mortality reduction was predicted as 13%, and 33% of the screen-detected cancers were overdiagnosed. When better quality of life for the post-treatment period could be achieved, an older age of 65 to 72 years for ending screening was obtained. Prostate cancer screening can be cost-effective when it is limited to two or three screens between ages 55 to 59 years. Screening above age 63 years is less cost-effective because of loss of QALYs because of overdiagnosis.
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