TY - JOUR
T1 - Quality-of-Life Effects of Prostate-Specific Antigen Screening
AU - Heijnsdijk, Eveline
AU - Wever, Elisabeth
AU - Auvinen, A
AU - Hugosson, J
AU - Ciatto, S
AU - Nelen, V
AU - Kwiatkowski, M
AU - Villers, A
AU - Paez, A
AU - Moss, SM
AU - Zappa, M
AU - Tammela, TLJ
AU - Makinen, T
AU - Carlsson, S
AU - Korfage, Ida
AU - Bot, Marie-louise
AU - Otto, Suzie
AU - Draisma, Gerrit
AU - Bangma VERVALLEN, CH
AU - Roobol - Bouts, Monique
AU - Schröder, Fritz
AU - de Koning, Harry
PY - 2012
Y1 - 2012
N2 - Background After 11 years of follow-up, the European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a 29% reduction in prostate-cancer mortality among men who underwent screening for prostate-specific antigen (PSA) levels. However, the extent to which harms to quality of life resulting from overdiagnosis and treatment counterbalance this benefit is uncertain. Methods On the basis of ERSPC follow-up data, we used Microsimulation Screening Analysis (MISCAN) to predict the number of prostate cancers, treatments, deaths, and quality-adjusted life-years (QALYs) gained after the introduction of PSA screening. Various screening strategies, efficacies, and quality-of-life assumptions were modeled. Results Per 1000 men of all ages who were followed for their entire life span, we predicted that annual screening of men between the ages of 55 and 69 years would result in nine fewer deaths from prostate cancer (28% reduction), 14 fewer men receiving palliative therapy (35% reduction), and a total of 73 life-years gained (average, 8.4 years per prostate-cancer death avoided). The number of QALYs that were gained was 56 (range, -21 to 97), a reduction of 23% from unadjusted life-years gained. To prevent Conclusions The benefit of PSA screening was diminished by loss of QALYs owing to postdiagnosis long-term effects. Longer follow-up data from both the ERSPC and quality-of-life analyses are essential before universal recommendations regarding screening can be made. (Funded by the Netherlands Organization for Health Research and Development and others.)
AB - Background After 11 years of follow-up, the European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a 29% reduction in prostate-cancer mortality among men who underwent screening for prostate-specific antigen (PSA) levels. However, the extent to which harms to quality of life resulting from overdiagnosis and treatment counterbalance this benefit is uncertain. Methods On the basis of ERSPC follow-up data, we used Microsimulation Screening Analysis (MISCAN) to predict the number of prostate cancers, treatments, deaths, and quality-adjusted life-years (QALYs) gained after the introduction of PSA screening. Various screening strategies, efficacies, and quality-of-life assumptions were modeled. Results Per 1000 men of all ages who were followed for their entire life span, we predicted that annual screening of men between the ages of 55 and 69 years would result in nine fewer deaths from prostate cancer (28% reduction), 14 fewer men receiving palliative therapy (35% reduction), and a total of 73 life-years gained (average, 8.4 years per prostate-cancer death avoided). The number of QALYs that were gained was 56 (range, -21 to 97), a reduction of 23% from unadjusted life-years gained. To prevent Conclusions The benefit of PSA screening was diminished by loss of QALYs owing to postdiagnosis long-term effects. Longer follow-up data from both the ERSPC and quality-of-life analyses are essential before universal recommendations regarding screening can be made. (Funded by the Netherlands Organization for Health Research and Development and others.)
U2 - 10.1056/NEJMoa1201637
DO - 10.1056/NEJMoa1201637
M3 - Article
C2 - 22894572
SN - 0028-4793
VL - 367
SP - 595
EP - 605
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 7
ER -