Table 2.2. 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 Pataky et al 2014

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Clinical practice guidelines for PSA testing and early management of test-detected prostate cancer > Table 2.2. 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 Pataky et al 2014


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download icon Table 2.2. 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 Pataky et al 2014

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Protocol specifications Outcomes*
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
10 40–74 PSA ≥ 3.0 ng/mL 2 years 22.8 3.4 0.70 0.81§ 4.86 23.8
15 50–74 PSA ≥ 3.0 ng/mL 2 years 22.5 3.2 0.68 0.80§ 4.71 25.0
16 50–74 PSA ≥ 3.0 ng/mL 2 years if PSA > median for age; 4 years if PSA < median for age 22.5 3.2 0.68 0.80§ 4.73 24.9
20 55–74 PSA ≥ 3.0 ng/mL 2 years 21.7 2.9 0.64 0.74§ 4.57 25.3
23 60–74 PSA ≥ 3.0 ng/mL 2 years 22.1 3.2 0.63 0.69§ 4.97 22.0
29 50–74 PSA ≥ 3.0 ng/mL up to age 69 years and PSA ≥ 4.0 ng/mL for men aged ≥ 70 years 2 years 17.4 2.3 0.60 0.74§ 3.86 32.0
31 50–74 PSA ≥ 3.0 ng/mL 4 years 21.8 2.5 0.55 0.64§ 4.57 25.5
32

Gøteborg

50–69 PSA ≥ 3.0 ng/mL 2 years 19.1 2.1 0.55 0.71§ 3.79 34.1
43 50–74 PSA ≥ 3.0 ng/mL up to age 69 years and PSA ≥ 4.0 ng/mL for men aged ≥ 70 years 4 years 15 1.4 0.44 0.57§ 3.28 39.5
47 55–69 PSA ≥ 3.0 ng/mL 4 years 15.5 1.1 0.37 0.49§ 2.99 44.3

Source: Pataky et al (2014)[1]

The protocol that most closely approximates the protocol used by the Gøteborg centre of the ERSPC is shown highlighted.

*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 age 90[1]

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).

‡ Protocol 32 approximates the screening strategy used in the Gøteborg centre of the ERSPC

§ Pataky et al (2014)[1] 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.

References

  1. 1.0 1.1 1.2 Pataky R, Gulati R, Etzioni R, Black P, Chi KN, Coldman AJ, et al. Is prostate cancer screening cost-effective? A microsimulation model of prostate-specific antigen-based screening for British Columbia, Canada. Int J Cancer 2014 Aug 15;135(4):939-47 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24443367.