Quality-of-Life Effects of Prostate-Specific Antigen Screening

Eveline Heijnsdijk, Elisabeth Wever, A Auvinen, J Hugosson, S Ciatto, V Nelen, M Kwiatkowski, A Villers, A Paez, SM Moss, M Zappa, TLJ Tammela, T Makinen, S Carlsson, Ida Korfage, Marie-louise Bot, Suzie Otto, Gerrit Draisma, CH Bangma VERVALLEN, Monique Roobol - BoutsFritz Schröder, Harry de Koning

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Abstract

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.)
Original languageUndefined/Unknown
Pages (from-to)595-605
Number of pages11
JournalNew England Journal of Medicine
Volume367
Issue number7
DOIs
Publication statusPublished - 2012

Research programs

  • EMC MM-03-49-01
  • EMC NIHES-02-65-01

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