Swedish Simulation Model Study in Prostate Cancer: Focus on PSA Testing
Posted: Tuesday, August 10, 2021
The advent of prostate-specific antigen (PSA) testing seems to be linked with more men being diagnosed with prostate cancer, especially low- and intermediate-risk disease, twice as many men receiving curative treatment, and a 15% decrease in mortality, according to a recent simulation-based study of the population of Sweden. Hans Garmo, PhD, of Regional Cancer Center Uppsala Örebro in Uppsala, Sweden, and colleagues published their results in JAMA Network Open.
“These results are consistent with the findings of a systematic review by Fenton et al, which concluded that an increased diagnostic activity (the introduction of PSA screening) reduced prostate cancer mortality but was associated with overdiagnosis and possibly overtreatment,” the authors wrote.
The study included 188,884 men diagnosed with prostate cancer in Sweden between 1996 (the beginning of widespread PSA testing) and 2016. The patients were drawn from the National Prostate Cancer Register of Sweden. The researchers compared these men with a simulated cohort. In the simulation, prostate cancer diagnostic activity remained constant from 1996 to 2016. This model simulates real-life scenarios, not clinical trials. The authors ran the simulation 200 times.
Compared with the simulation, the real number of men diagnosed with prostate cancer since PSA testing became available was 48% higher (423 men compared with 286). The number of men diagnosed with low- or intermediate-risk cancer was 148% higher (221 compared with 89). There was a 108% increase in the number of men who received curative treatment (152 compared with 73). Deaths from prostate cancer were up to 15% lower.
“The benefits of a higher diagnostic activity in terms of reduced prostate cancer mortality increases over time,” the authors noted, “so the benefits of high diagnostic activity would probably be greater in a future evaluation.”
Disclosure: The study authors reported no conflicts of interest.
