Can Prostate Cancer Screening Reduce Mortality in Men Aged 75-79 Years? A Protocol for Target-trial Emulation

Area of Science:

• Urology
• Oncology
• Epidemiology

Background:

• Opportunistic prostate-specific antigen (PSA) testing is common in men aged 75-79.
• Current guidelines recommend PSA screening for men with ≥10 years of life expectancy, with previous age thresholds of 70-74 years.
• Swedish men aged 75-79 now have an average life expectancy exceeding 10 years, necessitating updated screening considerations.

Purpose of the Study:

• To evaluate the survival benefits of PSA-based screening in men aged 75-79 without a prior prostate cancer diagnosis.
• To assess the impact of PSA screening on all-cause and prostate cancer-specific mortality in this demographic.
• To provide evidence for potentially extending prostate cancer screening guidelines to older men.

Main Methods:

• Utilizing the Stockholm Prostate Cancer Diagnostics Register (2007-2023) for a target-trial emulation study.
• Employing sequential and clone-censor-weight emulations with an intention-to-screen analysis based on PSA test records.
• Analyzing survival outcomes using survival models and cumulative incidence functions (CIFs), with sensitivity analyses for follow-up duration and enrollment criteria.

Main Results:

• The study aims to determine if PSA screening in men aged 75-79 leads to a reduction in mortality.
• It will quantify the effect of screening on both all-cause and prostate cancer-specific mortality.
• Results will be compared across different follow-up periods and enrollment criteria.

Conclusions:

• This research seeks to establish whether PSA screening provides survival advantages for men aged 75-79.
• Findings will inform clinical recommendations regarding prostate cancer screening in older populations.
• The study will help clarify the balance between mortality reduction and the risk of overdiagnosis in this age group.