Quantifying the Role of PSA Screening in the US Prostate Cancer Mortality Decline

Overview

Journal Cancer Causes Control

Specialties Oncology
Public Health

Date 2007 Nov 21

PMID 18027095

Citations 150

Authors

Ruth Etzioni

Alex Tsodikov

Angela Mariotto

Aniko Szabo

Seth Falcon

Jake Wegelin

Dante DiTommaso

Kent Karnofski

Roman Gulati

David F Penson

Eric Feuer

Affiliations

Soon will be listed here.

Abstract

Objective: To quantify the plausible contribution of prostate-specific antigen (PSA) screening to the nearly 30% decline in the US prostate cancer mortality rate observed during the 1990s.

Methods: Two mathematical modeling teams of the US National Cancer Institute's Cancer Intervention and Surveillance Modeling Network independently projected disease mortality in the absence and presence of PSA screening. Both teams relied on Surveillance, Epidemiology, and End Results (SEER) registry data for disease incidence, used common estimates of PSA screening rates, and assumed that screening, by shifting disease from distant to local-regional clinical stage, confers a corresponding improvement in disease-specific survival.

Results: The teams projected similar mortality increases in the absence of screening and decreases in the presence of screening after 1985. By 2000, the models projected that 45% (Fred Hutchinson Cancer Research Center) to 70% (University of Michigan) of the observed decline in prostate cancer mortality could be plausibly attributed to the stage shift induced by screening.

Conclusions: PSA screening may account for much, but not all, of the observed drop in prostate cancer mortality. Other factors, such as changing treatment practices, may also have played a role in improving prostate cancer outcomes.

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References

Bolla M, Collette L, Blank L, Warde P, Dubois J, Mirimanoff R . Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet. 2002; 360(9327):103-6. DOI: 10.1016/s0140-6736(02)09408-4. View

Chen M, Troncoso P, Johnston D, Tang K, Babaian R . Optimization of prostate biopsy strategy using computer based analysis. J Urol. 1997; 158(6):2168-75. DOI: 10.1016/s0022-5347(01)68188-6. View

Shaw P, Etzioni R, Zeliadt S, Mariotto A, Karnofski K, Penson D . An ecologic study of prostate-specific antigen screening and prostate cancer mortality in nine geographic areas of the United States. Am J Epidemiol. 2004; 160(11):1059-69. DOI: 10.1093/aje/kwh336. View

Tsodikov A, Szabo A, Wegelin J . A population model of prostate cancer incidence. Stat Med. 2006; 25(16):2846-66. DOI: 10.1002/sim.2257. View

Albertsen P . What is the value of screening for prostate cancer in the US?. Nat Clin Pract Oncol. 2005; 2(11):536-7. DOI: 10.1038/ncponc0348. View

Etzioni R, Gulati R, Falcon S, Penson D . Impact of PSA screening on the incidence of advanced stage prostate cancer in the United States: a surveillance modeling approach. Med Decis Making. 2008; 28(3):323-31. DOI: 10.1177/0272989X07312719. View

Etzioni R, Cha R, Cowen M . Serial prostate specific antigen screening for prostate cancer: a computer model evaluates competing strategies. J Urol. 1999; 162(3 Pt 1):741-8. DOI: 10.1097/00005392-199909010-00032. View

Wasson J, Bubolz T, Lu-Yao G, Walker-Corkery E, Hammond C, Barry M . Transurethral resection of the prostate among medicare beneficiaries: 1984 to 1997. For the Patient Outcomes Research Team for Prostatic Diseases. J Urol. 2000; 164(4):1212-5. View

Zeliadt S, Potosky A, Etzioni R, Ramsey S, Penson D . Racial disparity in primary and adjuvant treatment for nonmetastatic prostate cancer: SEER-Medicare trends 1991 to 1999. Urology. 2004; 64(6):1171-6. DOI: 10.1016/j.urology.2004.07.037. View

10.

Thompson I, Goodman P, Tangen C, Lucia M, Miller G, Ford L . The influence of finasteride on the development of prostate cancer. N Engl J Med. 2003; 349(3):215-24. DOI: 10.1056/NEJMoa030660. View

11.

Berry D, Cronin K, Plevritis S, Fryback D, Clarke L, Zelen M . Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005; 353(17):1784-92. DOI: 10.1056/NEJMoa050518. View

12.

Barry M . Revisiting my personal decision about prostate-specific antigen testing in 2005. BJU Int. 2005; 96(7):954-6. DOI: 10.1111/j.1464-410X.2005.05796.x. View

13.

Mariotto A, Etzioni R, Krapcho M, Feuer E . Reconstructing PSA testing patterns between black and white men in the US from Medicare claims and the National Health Interview Survey. Cancer. 2007; 109(9):1877-86. DOI: 10.1002/cncr.22607. View

14.

Concato J, Wells C, Horwitz R, Penson D, Fincke G, Berlowitz D . The effectiveness of screening for prostate cancer: a nested case-control study. Arch Intern Med. 2006; 166(1):38-43. DOI: 10.1001/archinte.166.1.38. View

15.

Draisma G, Boer R, Otto S, van der Cruijsen I, Damhuis R, Schroder F . Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst. 2003; 95(12):868-78. DOI: 10.1093/jnci/95.12.868. View

16.

Babaian R, Toi A, Kamoi K, Troncoso P, Sweet J, Evans R . A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol. 1999; 163(1):152-7. View

17.

Telesca D, Etzioni R, Gulati R . Estimating lead time and overdiagnosis associated with PSA screening from prostate cancer incidence trends. Biometrics. 2007; 64(1):10-9. DOI: 10.1111/j.1541-0420.2007.00825.x. View

18.

Gee W, HOLTGREWE H, Blute M, Miles B, Naslund M, Nellans R . 1997 American Urological Association Gallup survey: Changes in diagnosis and management of prostate cancer and benign prostatic hyperplasia, and other practice trends from 1994 to 1997. J Urol. 1998; 160(5):1804-7. DOI: 10.1016/s0022-5347(01)62418-2. View

19.

Pinsky P, Andriole G, Kramer B, Hayes R, Prorok P, Gohagan J . Prostate biopsy following a positive screen in the prostate, lung, colorectal and ovarian cancer screening trial. J Urol. 2005; 173(3):746-50. DOI: 10.1097/01.ju.0000152697.25708.71. View

20.

Bill-Axelson A, Holmberg L, Ruutu M, Haggman M, Andersson S, Bratell S . Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med. 2005; 352(19):1977-84. DOI: 10.1056/NEJMoa043739. View