Estimation of treatment benefits when PSA screening for prostate cancer is discontinued at different ages
Received 28 August 2004; accepted 12 May 2005.
Abstract
Objectives
To estimate the declining benefits of screening for prostate cancer as patient age at screening increases. The benefits of prostate cancer screening decline with age because of the long natural history of prostate cancer and competing causes of death among older men.
Methods
We used a previously described Monte Carlo simulation based on a Markov model of prostate cancer detection in men aged 40 to 90 years and simulated prostate cancer screening in 1000 populations of 1,000,000 men each. The age at the final prostate-specific antigen test in the model was varied to simulate the discontinuation of screening from age 50 to 80 years. The model outputs were the number of men treated, the number of prostate cancer deaths prevented by treatment, and person-years of life saved.
Results
The relationship between treatments required to prevent a death was not constant but widened with age. Compared with screening to age 65 years, screening to age 75 and 80 years required twice and three times, respectively, the number of treatments per person-year of life saved.
Conclusions
Our results have helped to quantify the declining treatment benefit as the patient age at screening and treatment for prostate cancer increases. We believe that men older than 70 years should be carefully counseled about the declining benefits of prostate cancer detection with screening.
aDepartment of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
bDepartment of Epidemiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
cJames Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland
Reprint requests: H. Ballentine Carter, M.D., Department of Urology, 403 Marburg, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287-2101.
ABSTRACT