Table 2.3. Modelled outcomes of a range of PSA testing protocols sorted in decreasing order of probability of death from prostate cancer prevented reported by Gulati et al 2013

From Cancer Guidelines Wiki
Clinical practice guidelines for PSA testing and early management of test-detected prostate cancer > Table 2.3. Modelled outcomes of a range of PSA testing protocols sorted in decreasing order of probability of death from prostate cancer prevented reported by Gulati et al 2013


Back to guideline content page


download icon Table 2.3. Modelled outcomes of a range of PSA testing protocols sorted in decreasing order of probability of death from prostate cancer prevented reported by Gulati et al 2013

SIAN DONE

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
3 40–74 PSA > 2.5 ng/mL or vPSA > 0.35 ng/mL per year Annual (5 years if age< 50yrs and PSA level < 1 ng/mL) 44 6 0.85 1.00 7.08 16.6
4 40–74 PSA > 4.0 ng/mL or vPSA > 0.35 ng/mL per year Annual 45 5.8 0.84 1.00 6.90 17.3
5 50–74 PSA > 4.0 ng/mL or vPSA > 0.35 ng/mL per year Annual 44 5.5 0.81 0.96 6.84 17.3
6 40–74 PSA > 2.5 ng/mL Annual 32 4.9 0.81 0.96 6.08 19.5
7 50–74 PSA > 2.5 ng/mL Annual 31 4.7 0.78 0.94 6.01 20.1
8 40–74 PSA > 4.0 ng/mL Annual 22 3.5 0.72 0.88 4.79 25.5
9 40–74 PSA > 2.5 ng/mL 2 years 29 4 0.71 0.85 5.58 21.5
11 50–74 PSA > 4.0 ng/mL Annual 21 3.3 0.70 0.86 4.70 26.1
12 50–74 PSA > 4.0 ng/mL Annual (2 years if PSA level <2.5ng/mL) 21 3.3 0.70 0.86 4.70 26.1
13 50–74 PSA > 2.5 ng/mL 2 years 29 3.8 0.69 0.84 5.51 22.1
14 40–74 PSA > 4.0 ng/mL or vPSA > 0.35 ng/mL per year 2 years 26 3.6 0.69 0.84 5.13 23.7
17 40–69 PSA > 4.0 ng/mL or vPSA > 0.35 ng/mL per year Annual 41 3.9 0.67 0.89 5.77 23.0
18 50–74 PSA > 4.0 ng/mL or vPSA > 0.35 ng/mL per year 2 years 26 3.4 0.67 0.82 5.07 24.1
19 50–69 PSA > 4.0 ng/mL or vPSA > 0.35 ng/mL per year Annual 40 3.7 0.65 0.85 5.67 23.1
21 40–74 PSA > 4.0 ng/mL 2 years 20 2.8 0.64 0.78 4.42 27.6
22 40–74 PSA > 95th percentile for age§ Annual 16 2.4 0.64 0.83 3.78 34.3
24 40–69 PSA > 2.5 ng/mL Annual 27 3.1 0.63 0.84 4.85 27.5
25 50–69 PSA > 2.5 ng/mL Annual 27 2.9 0.61 0.82 4.75 28.3
26 50–74 PSA > 4.0 ng/mL 2 years 20 2.7 0.61 0.77 4.34 29.1
27 50–74 PSA >95th percentile for age§ Annual 15 2.3 0.61 0.81 3.71 35.8
30 45–74 PSA > 4.0 ng/mL 2 years ( 5 years if PSA level < median for age) 19 2.4 0.58 0.75 4.09 31.6
33 40–69 PSA > 4.0 ng/mL Annual 17 2 0.54 0.75 3.66 37.9
34 40–74 PSA > 95th percentile for age§ 2 years 14 1.8 0.54 0.73 3.39 39.9
35 40–69 PSA > 2.5 ng/mL 2 years 24 2.2 0.52 0.72 4.20 33.0
36 50–69 PSA > 4.0 ng/mL Annual 17 1.8 0.51 0.73 3.58 40.0
37 40–69 PSA > 95th percentile for age§ Annual 15 1.7 0.51 0.73 3.29 43.5
38 50–74 PSA > 95th percentile for age§ 2 years 14 1.7 0.51 0.70 3.32 41.3
39 40–69 PSA > 4.0 ng/mL or vPSA > 0.35 ng/mL per year 2 years 21 1.9 0.50 0.71 3.90 36.4
40

ERSPC (Gøteborg)

50–69 PSA > 2.5 ng/mL 2 years 23 2 0.49 0.70 4.12 34.7
41 50–69 PSA >95th percentile for age§ Annual 14 1.5 0.48 0.71 3.20 46.2
42 50–69 PSA >4.0 ng/mL or vPSA > 0.35 ng/mL per year 2 years 20 1.8 0.47 0.67 3.85 37.0
44 40–69 PSA > 4.0 ng/mL 2 years 15 1.4 0.43 0.64 3.18 46.8
45 40–69 PSA > 95th percentile for age§ 2 years 13 1.3 0.42 0.63 2.99 50.2
46 50–69 PSA > 4.0 ng/mL 2 years 14 1.3 0.41 0.61 3.11 47.8

Source: Gulati et al (2013)[1]

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

vPSA: PSA velocity

*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 the end of life[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).

† Modelled protocols from all models were ranked in order of decreasing probability that prostate cancer death was prevented

§95th percentiles were 2.5, 3.5, 4.5 and 6.5 ng/mL for ages 40–49, 50–59, 60–69 and 70–74 years, respectively.

‡ Protocol 28 approximates the protocol used in the Gøteborg centre of the ERSPC[2]

References

  1. 1.0 1.1 Gulati R, Gore JL, Etzioni R. Comparative effectiveness of alternative prostate-specific antigen--based prostate cancer screening strategies: model estimates of potential benefits and harms. Ann Intern Med 2013 Feb 5;158(3):145-53 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23381039.
  2. 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.

Back to top