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Related Experiment Videos

Screening for prostate cancer. A decision analytic view

M D Krahn1, J E Mahoney, M H Eckman

  • 1Department of Medicine, University of Toronto (Ontario), Canada.

JAMA
|September 14, 1994
PubMed
Summary

Prostate cancer screening using PSA, TRUS, or DRE does not improve health outcomes and increases costs. These screening methods are not recommended for asymptomatic men, as they may lead to poorer health and higher expenses.

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Area of Science:

  • Urology
  • Health Economics
  • Preventive Medicine

Background:

  • Prostate cancer screening is widely debated.
  • Current methods include prostate-specific antigen (PSA) testing, digital rectal examination (DRE), and transrectal ultrasound (TRUS).
  • The clinical and economic impact of these screening strategies requires thorough evaluation.

Purpose of the Study:

  • To determine the clinical and economic effects of prostate cancer screening.
  • To compare screening with prostate-specific antigen (PSA), transrectal ultrasound (TRUS), and digital rectal examination (DRE) against no screening.

Main Methods:

  • A decision analytic cost-utility analysis was performed.
  • Four screening strategies were compared to a no-screening strategy.

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  • Life expectancy, quality-adjusted life expectancy (QALE), and cost-utility ratios were calculated for different populations.

    • Main Results:

    • Screening with PSA or TRUS in men aged 50-70 prolonged life expectancy but reduced QALE.
    • DRE alone did not reduce mortality.
    • All screening programs increased healthcare costs, with results sensitive to treatment efficacy.

    Conclusions:

    • The study does not support screening asymptomatic men for prostate cancer using PSA, TRUS, or DRE.
    • Screening may lead to worse health outcomes and significantly higher costs.
    • Individualized assessment of comorbidity and risk tolerance may identify select candidates, but high-prevalence populations do not improve screening benefits.