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What explains the differences between centres in the European screening trial? A simulation study.

Jaakko Nevalainen1, Ulf-Håkan Stenman2, Teuvo L Tammela3

  • 1University of Tampere, School of Health Sciences, Tampere, Finland.

Cancer Epidemiology
|November 28, 2016
PubMed
Summary

The European Randomised study of Screening for Prostate Cancer (ERSPC) found screening reduced prostate cancer mortality by 21%. Differences in screening protocols only marginally explain variations in effectiveness across study centers.

Keywords:
Longitudinal PSA modelProstate cancerProstate-specific antigenScreeningSimulation model

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Area of Science:

  • Urology
  • Public Health
  • Epidemiology

Background:

  • The European Randomised study of Screening for Prostate Cancer (ERSPC) is a multicentre trial investigating prostate cancer (PrCa) screening in men aged 55-69.
  • The ERSPC demonstrated a 21% reduction in PrCa mortality over 13 years, but effectiveness varied by center.
  • Potential explanations for center-specific variations include differences in screening protocols.

Purpose of the Study:

  • To assess if variations in prostate cancer mortality reduction across ERSPC centers can be attributed to differing screening protocols.
  • To analyze the impact of alternative screening strategies on prostate cancer mortality through simulation.

Main Methods:

  • A simulation model was developed to examine center-specific differences in prostate cancer mortality.
  • The model estimated the effects of alternative screening protocols, including PSA thresholds (3 vs. 4 ng/ml) and screening intervals (2 vs. 4 years).

Main Results:

  • Simulations reproducing observed outcomes suggested that differences in screening protocols only marginally explain variations in prostate cancer mortality reduction.
  • The study found that screening regimens with different PSA thresholds or intervals yielded similar results to those observed in the trial.

Conclusions:

  • Variations in prostate cancer screening effectiveness across centers are not significantly explained by differences in screening protocols.
  • The limited screening impact observed in Finland may be due to contamination in the control arm and unexpectedly low prostate cancer mortality rates.