Original Paper

Cancer Causes & Control

, Volume 19, Issue 2, pp 175-181

First online:

Quantifying the role of PSA screening in the US prostate cancer mortality decline

  • Ruth EtzioniAffiliated withFred Hutchinson Cancer Research Center Email author 
  • , Alex TsodikovAffiliated withDepartment of Biostatistics, University of California at DavisDepartment of Biostatistics, University of Michigan
  • , Angela MariottoAffiliated withDivision of Cancer Control and Population Sciences, National Cancer Institute
  • , Aniko SzaboAffiliated withHuntsman Cancer InstituteMedical College of Wisconsin
  • , Seth FalconAffiliated withFred Hutchinson Cancer Research Center
  • , Jake WegelinAffiliated withDepartment of Biostatistics, University of California at DavisVirginia Commonwealth University
  • , Dante diTommasoAffiliated withFred Hutchinson Cancer Research CenterNovartis Pharmaceuticals
  • , Kent KarnofskiAffiliated withFred Hutchinson Cancer Research Center
  • , Roman GulatiAffiliated withFred Hutchinson Cancer Research Center
    • , David F. PensonAffiliated withKeck School of Medicine and Norris Cancer Center, University of Southern California
    • , Eric FeuerAffiliated withDivision of Cancer Control and Population Sciences, National Cancer Institute

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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.

Keywords

Prostate-specific antigen Prostate cancer Public health Computer simulation