Quantifying the role of PSA screening in the US prostate cancer mortality decline
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.
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.
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.
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.
KeywordsProstate-specific antigen Prostate cancer Public health Computer simulation
This research was supported by U01 CA88160, a co-operative agreement between the National Cancer Institute and the collaborating institutions. This funding mechanism explicitly requires collaboration between the awardees and investigators at the funding source, who provide guidance to the awardees regarding goals and deliverables of the funded projects. In the work presented here, the collaborating institutions were responsible for model development, and investigators at the funding source were responsible for overall guidance and for providing key model inputs, such as other-cause mortality and PSA dissemination trends. These inputs were used by both models for standardization and comparability purposes.
- 6.National Cancer Institute Surveillance Research Program SEER*Stat software, 6.2.4 edn. Available at: http://www.seer.cancer.gov/seerstat
- 7.Etzioni R, Gulati R, Falcon S, Penson D (2007) Impact of PSA screening on the incidence of advanced stage prostate cancer in the US: a surveillance modeling approach. Med Decis Making (in press)Google Scholar
- 12.National Cancer Institute—Cancer Intervention and Surveillance Modeling Network (CISNET). Home Page: http://cisnet.cancer.gov/
- 20.Telesca D, Etzioni R, Gulati R (2007) Estimating lead time and overdiagnosis associated with PSA screening from prostate cancer incidence trends. Biometrics (in press)Google Scholar
- 21.de Koning HJ, Auvinen A, Berenguer Sanchez A et al (2002) Large-scale randomized prostate cancer screening trials: program performances in the European Randomized Screening for Prostate Cancer trial and the Prostate, Lung, Colorectal and Ovary Cancer trial. Int J Cancer 97:237–244PubMedCrossRefGoogle Scholar
- 23.Gold M, Siegel J, Russell L, Weinstein M (1996) Cost-effectiveness in health and medicine. Oxford University Press, New YorkGoogle Scholar
- 33.National Cancer Institute Surveillance, Epidemiology, and End Results. Home Page: http://seer.cancer.gov/
- 34.National Center for Health Statistics. Home Page: http://www.cdc.gov/nchs/
- 36.National Center for Health Statistics: National Health Interview Survey (NHIS). Home Page: http://www.cdc.gov/nchs/nhis.htm
- 37.Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute SEER-Medicare linked databaseGoogle Scholar