Comparative Efficiency of Prostate-Specific Antigen Screening Strategies for Prostate Cancer Detection

Reviewers: Li Liu, MD
Source: Source: JAMA 284(11):1399-1405, (September) 2000

Introduction

Digital rectal examination and measurement of serum prostate specific antigen (PSA) are the most widely used screening tests for prostate cancer. The American Urological Association and the American Cancer Society recommend that all men 50 years old or older undergo routine screening of PSA every year, and that men with a family history of prostate cancer at an early age and men of African-American decent undergo PSA screening annually starting at age 40. In this study, the researchers assessed the efficiency of various PSA screening strategies.

Method

A computer model was developed to compare the costs and benefits of various prostate cancer screening strategies. Different age ranges for PSA testing, different testing intervals, and different PSA thresholds for triggering prostate biopsy were evaluated.

Results

• PSA testing at ages 40 and 45 years followed by biennial testing beginning at age 50 years appeared to be more cost effective.
• This recommended strategy prevented 3.3 deaths, with an additional 7,500 PSA tests and 450 prostate biopsies as compared with the current standard strategy of preventing 3.2 deaths, with an additional 10,500 PSA tests and 600 prostate biopsies.
• Setting the PSA threshold for prostate biopsy at below 4.0 ng/mL or using age-specific PSA thresholds were not more efficient than use of a PSA threshold of 4.0 ng/mL.

Discussion

In this study, the standard protocol of annual PSA screening in men older than 50 years was less efficacious and less-effective than testing at ages 40 and 45, followed by biennial screening starting at age 50. The analysis was based on the computer model and the recommended strategy by the researchers should be tested by population based epidemiology studies.