Serial prostate specific antigen screening for prostate cancer: a computer model evaluates competing strategies.

Area of Science:

• Urology
• Oncology
• Medical Informatics

Background:

• Prostate cancer screening often involves prostate specific antigen (PSA) testing.
• Current screening strategies balance early detection with potential harms like over-diagnosis and false positives.
• Optimizing PSA screening protocols is crucial for maximizing benefits and minimizing risks.

Purpose of the Study:

• To compare different prostate specific antigen (PSA) screening strategies.
• To evaluate strategies based on expected years of life saved, number of screens, false-positive screens, and over-diagnosis rates.
• To identify the most effective and efficient PSA screening approach for prostate cancer.

Main Methods:

• A computer model simulating disease progression, diagnosis, PSA levels, and screening was utilized.
• The model was calibrated using Surveillance, Epidemiology, and End Results (SEER) Program data from the mid-1980s for baseline conditions.
• Simulations compared biannual screening versus annual screening with different PSA thresholds.

Main Results:

• Biannual PSA screening reduced the number of screens and false-positive tests by nearly 50% compared to annual screening, while preserving 93% of life-years saved.
• Using age-specific PSA thresholds for annual screening decreased false-positive screens by 27% and over-diagnosis by one-third, retaining 95% of life-years saved.
• Sensitivity analyses confirmed the consistent efficacy of biannual screening.

Conclusions:

• Biannual PSA screening presents a cost-effective alternative to annual screening for prostate cancer.
• Employing age-specific PSA thresholds in annual screening significantly reduces false positives and over-diagnosis.
• These optimized annual screening strategies maintain the majority of survival benefits observed with standard screening protocols.