A PSA on PSA

The controversy over prostate cancer screening is a familiar one to pathologists. To screen, or not to screen? Many believe the costs and risks outweigh the benefits, and feel that more personalized – or more conservative – strategies to optimize screening are needed. But what are those strategies, and will they really help? Until now, experts have been uncertain. A new economic analysis from Seattle, which analyzes the cost-effectiveness of 18 different prostate-specific antigen (PSA) screening strategies, mayhold answers (1). The study involved creating a simulated cohort of 40-year-old men. The cohort was run through each of the 18 screening strategies, which varied by starting and stopping ages, screening intervals, biopsy referral criteria and choice of treatment practice (either contemporary, based on age and cancer stage and grade, or selective, wherein cases with Gleason score <7 or stage

With contemporary treatment, the study found that only strategies with age-dependent thresholds or biopsy referrals for patients with PSA levels >10 ng/mL provided increased quality-adjusted life-years (QALYs). The only strategy that provided effective returns in terms of cost per QALY was screening patients aged 55 to 69 every four years. The more conservative selective treatment approach provided somewhat more benefit; all strategies were associated with increased QALYs and several (involving different age thresholds, screening intervals and referral criteria) were cost-effective. What does this mean for the clinic? PSA screening can, according to this research, be cost-effective – but only if both screening and subsequent treatment are conservatively managed. It’s important to ensure that such approaches don’t overlook patients in need of more extensive care, though, and if the correct balance can be found, it’s possible that the future will see fewer PSA tests ordered, fewer patients sent for biopsies, and an improvement in the cost-to-benefit ratio of prostate cancer screening.

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References

1. JA Roth et al., “Economic analysis of prostate-specific antigen screening and selective treatment strategies”, JAMA Oncol, [Epub ahead of print] (2016). PMID: 27010943.

About the Author(s)

Michael Schubert

While obtaining degrees in biology from the University of Alberta and biochemistry from Penn State College of Medicine, I worked as a freelance science and medical writer. I was able to hone my skills in research, presentation and scientific writing by assembling grants and journal articles, speaking at international conferences, and consulting on topics ranging from medical education to comic book science. As much as I’ve enjoyed designing new bacteria and plausible superheroes, though, I’m more pleased than ever to be at Texere, using my writing and editing skills to create great content for a professional audience.

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