Table 2.1. Modelled outcomes of a range of PSA testing protocols sorted in decreasing order of probability of death from prostate cancer prevented for protocols reported by Heijnsdijk et al 2012
|Ranking †||PSA testing age range||Criteria for biopsy referral||Interval between PSA tests||Probability of ≥ 1 FP %||Probability of over-diagnosis %||Probability that prostate cancer death is prevented %||Mean months of life gained per man tested||NND||Mean months of life gained per man diagnosed|
|28 ERSPC‡||55–69||~3ng/mL||4 years||36.7||2.9||0.60||0.62§||5||20.8|
Source: Heijnsdijk et al (2012)
The protocol that most closely approximates the ERSPC protocol is shown highlighted. The protocols above it appear to perform relatively better in preventing death from prostate cancer.
*Outcomes were calculated as follows:
Probability of ≥ 1 FP % = percentage of men having one or more false positive tests over the age range of testing Probability of over-diagnosis % = percent of men having an over-diagnosed prostate cancer during the age range of testing
Probability that prostate cancer death is prevented % = percent of men prevented from dying from prostate cancer from date of first testing to 100 years of age
Mean months of life gained per man tested = total months of life gained by men prevented from dying from prostate cancer averaged over all men tested
NND = Number of men needed to diagnose and treat for prostate cancer to prevent one death from prostate cancer (probability of over diagnosis % divided by the probability that death from prostate cancer is prevented %) Mean months of life gained per man diagnosed = Mean months of life gained per man whose death from prostate cancer was prevented by testing divided by the NND (calculated as mean months of life gained per man tested divided by probability that prostate cancer death is prevented % multiplied by 100 and the result divided by the NND).
† Modelled protocols from all models were ranked in order of decreasing probability that prostate cancer death was prevented
§ Heijnsdijk et al (2012) did not provide an estimate of this value. It was estimated by using the following approach: life years gained (undiscounted) per 100 men tested multiplied by 12 and divided by 100.
‡ Protocol 28 approximates the screening strategy used in the intervention arm of ERSPC
- Heijnsdijk EA, Wever EM, Auvinen A, Hugosson J, Ciatto S, Nelen V, et al. Quality-of-life effects of prostate-specific antigen screening. N Engl J Med 2012 Aug 16;367(7):595-605 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22894572.
- Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med 2012 Mar 15;366(11):981-90 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22417251.