February 05, 2020
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Prostate cancer screening program based on patient risk yields greatest benefit

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Screening men for prostate cancer based on their risk for the disease can potentially reduce overdiagnosis and improve a program’s cost-effectiveness, according to data from a modeling study published in PLoS One.

Tom Callender, MSc, MB, public health registrar and academic clinical fellow at University College London, and colleagues created a hypothetical cohort of 4.48 million older men in England. The men were followed until they reached 90 years of age. Researchers then compared the benefits and harms of three screening models:

  • no screening;
  • age-based screening with PSA testing every 4 years; and
  • risk-tailored screening based on age and polygenic risk profile.

In the model, men were screened between the ages of 55 to 69 years, Callender and colleagues wrote.

The researchers found that, compared with no screening, age-based screening prevented the most deaths from prostate cancer over a 35-year period — 39,272 (95% uncertainty interval [UI], 16,792-59,685) — but it did so at the expense of 94,831 (95% UI, 84,827-105,630) overdiagnoses. Age-based screening also was the least cost-effective approach, researchers said.

Callender and colleagues wrote that risk-based screening “improved the benefit/harm tradeoff and cost-effectiveness of a screening program for prostate cancer.” Specifically, offering screening to men at a 10-year absolute risk threshold of 4% led to 64,384 (95% UI, 57,382-72,050) fewer overdiagnoses but averted 9,695 (95% UI, 2,853-15,851) fewer deaths from prostate cancer compared with age-based screening. At that same threshold, risk-based screening was cost-effective 57.4% of the time when it was assumed society would cover 30,000 euros ($39,386) of the costs for each quality-adjusted life-year (QALY). The cost-effectiveness of the model rose as the amount society was willing to cover rose.

Ultimately, the best screening strategy “will depend on both a society’s willingness to pay for each QALY gained as well as the tradeoff between benefits and harms considered acceptable both at an individual and population level,” the researchers wrote.

Callender and colleagues noted that their findings compare favorably with a microsimulation model that was previously conducted in United States.by Janel Miller

Disclosures: The authors report no relevant financial disclosures.