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PSA-Stratified Screening for Prostate Cancer


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Previous studies have shown that men with low prostate-specific antigen (PSA) levels (< 1.0 ng/mL) between ages 44 to 60 have a very low risk of developing prostate cancer in the future. A study published by Heijnsdijk et al in JNCI: Journal of the National Cancer Institute investigated benefits and harms of screening strategies associated with lengthening the screening interval when PSA level is below 1.0 ng/mL at ages 45 or 50 or discontinuing screening when PSA level is below 1.0 ng/mL at age 60.

Using statistical modeling techniques, researchers predicted the harms (measured in tests and overdiagnoses) and benefits (measured in lives saved and life-years gained) of PSA-stratified screening strategies vs traditionally recommended screening for men between 45 and 69 every other year.

KEY POINTS

  • Screening 10,000 men age 45 to 69 every other year would require more than 110,000 screens and result in up to 348 overdiagnoses.
  • Lengthening the screening interval from 2 to 8 years would result in 46.8% to 47.0% fewer tests administered, a decrease of overdiagnosis by 5% to 24%, and would result in 3.1% to 3.8% fewer lives saved.

Findings

The models projected that screening 10,000 men age 45 to 69 every other year would require more than 110,000 screens and result in up to 348 overdiagnoses. The investigators found that lengthening the screening interval from 2 to 8 years would result in 46.8% to 47.0% fewer tests administered, a decrease of overdiagnosis by 5% to 24%, and would result in 3.1% to 3.8% fewer lives saved.

Additionally, the models predicted that discontinuing screening at age 60 for everyone would greatly reduce overdiagnoses (by 79% to 82%) but would save substantially fewer lives compared to screening until age 69.

“This study shows the power of comparative modeling: by using two models with different underlying assumptions, we can identify uncertainty around the outcomes,” said lead author Eveline Heijnsdijk, PhD.

The authors concluded, “Relative to a biennial screening strategy, PSA-stratified screening strategies investigated in this study substantially reduced the testing burden and modestly reduced overdiagnosis while preserving the majority of lives saved. Further research is needed to clarify the link between PSA growth and disease progression.”

Disclosure: For full disclosures of the study authors, visit academic.oup.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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