This Article Full Text (PDF) All Versions of this Article: 0272989X07312719v1 28/3/323    most recent References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Etzioni, R. Articles by Penson, D. F. Search for Related Content PubMed PubMed Citation Articles by Etzioni, R. Articles by Penson, D. F. Pubmed/NCBI databases Medline Plus Health Information Prostate Cancer Social Bookmarking                   What's this?

Impact of PSA Screening on the Incidence of Advanced Stage Prostate Cancer in the United States: A Surveillance Modeling Approach

Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, retzioni{at}fhcrc.org

Roman Gulati, MS

Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington

Seth Falcon, MS

Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington

David F. Penson, MD, MPH

Norris Cancer Center, University of Southern California, Los Angeles, California

Background and objective. Both the detection and the treatment of prostate cancer have undergone important clinical advances. Simultaneously, both distant stage incidence and disease-specific mortality have fallen in the United States. A recent study suggests that if prostate-specific antigen (PSA) testing explains the decline in distant stage incidence, then it may be largely responsible for the decline in mortality. The objective was to quantify this link between PSA screening and the decline in distant stage incidence. Methods. A fixed-cohort simulation model of prostate cancer progression and screening was adapted to a population-based model that integrates new data on trends in testing and biopsy practices. The model was calibrated to pre-PSA incidence and then screening was superimposed, obtaining incidence projections in the absence and presence of testing. This approach permits calculation of clinically relevant measures for model validation and direct assessment of the role of testing in the distant stage incidence decline. Results. The model validated well with prior studies of natural history, and the sensitivity analysis indicated that the findings were robust to variation in model parameters. Model results indicate that PSA screening accounts for approximately 80% of the observed decline in distant stage incidence. Conclusions. PSA screening contributed to the observed declines in distant stage incidence and mortality in the 1990s. However, additional factors, such as increasing awareness of prostate cancer and advances in treatment, have probably also played a role in these trends.

Key Words: public health • prostatic neoplasms • prostate-specific antigen • computer simulation.

This version was published on June 1, 2008

Medical Decision Making, Vol. 28, No. 3, 323-331 (2008)
DOI: 10.1177/0272989X07312719


CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				N. Pashayan, P. Pharoah, D. E Neal, F. Hamdy, J. Donovan, R. M Martin, D. Greenberg, and S. W Duffy Stage shift in PSA-detected prostate cancers - effect modification by Gleason score J Med Screen, June 1, 2009; 16(2): 98 - 101. [Abstract] [Full Text] [PDF]

				G. Draisma, R. Etzioni, A. Tsodikov, A. Mariotto, E. Wever, R. Gulati, E. Feuer, and H. de Koning Lead Time and Overdiagnosis in Prostate-Specific Antigen Screening: Importance of Methods and Context J Natl Cancer Inst, March 18, 2009; 101(6): 374 - 383. [Abstract] [Full Text] [PDF]