The socioeconomic implications of prostate-specific antigen screening

Area of Science:

• Urology
• Health Economics
• Public Health

Background:

• Prostate-specific antigen (PSA) screening for prostate cancer is widespread.
• Screening leads to stage migration and earlier treatment, increasing healthcare costs.
• The cost-effectiveness of PSA screening is debated due to limited data on survival benefits.

Purpose of the Study:

• To analyze the cost-effectiveness of prostate-specific antigen (PSA) screening for prostate cancer.
• To evaluate the impact of screening on healthcare costs and patient survival.
• To review existing models and data for assessing PSA screening's value.

Main Methods:

• Review of decision analysis models for prostate cancer screening and treatment.
• Analysis of quantitative models using concrete parameters like cost, complication rates, and survival data.
• Examination of how model assumptions influence cost-effectiveness results.

Main Results:

• PSA screening increases healthcare costs primarily due to earlier treatment of prostate cancer.
• Some models show little to no benefit from PSA screening, while others demonstrate effectiveness and cost-effectiveness.
• Quantitative analysis suggests PSA screening is effective and cost-effective compared to existing interventions.

Conclusions:

• The primary driver of increased costs is stage migration and earlier treatment, not detection of insignificant cancers.
• Long-term survival benefits of PSA screening, particularly for men aged 50-70, are realized later in life and require further validation.
• Randomized controlled trials are needed to definitively quantify the costs and benefits of PSA screening for informed societal decisions.