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Prostate screening trade-offs worsen with age in models

Models estimated 2.7–3.1 overdiagnoses per prostate cancer death prevented at 72 versus 4.5–5.1 at 76 in men without other illnesses.

Paper by Roman Gulati, Krithika Suresh, Sarah P. Psutka, +4 more authorsRuth D. Etzioni · Division of Public Health Sciences Fred Hutch Cancer Center Seattle Washington USA
Figure 1. Open in figure viewerPowerPoint Noncancer survival by comorbidity group for men aged 72 years previously estimated using SEER-Medicare data.
Open the figure at full size
Figure 1. Open in figure viewerPowerPoint Noncancer survival by comorbidity group for men aged 72 years previously estimated using SEER-Medicare data.Open in figure viewerPowerPoint Noncancer survival by comorbidity group for men aged 72 years previously estimated using SEER-Medicare data.Gulati et al., CC BY-NC

Our read

Interventions
Studied:
Computational study of simulated men without diagnosed prostate cancer, lifetime
What changed:
In men without comorbidities, overdiagnoses per cancer death prevented rose from 2.7–3.1 at age 72 years to 4.5–5.1 at age 76 years
The catch:
MRI and targeted biopsy accuracy were assumed constant across ages and comorbidity groups

Editor of record: Boris Djordjevic · AgingResearch.News

Paper
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Men screened every two years from ages 50 to 70, with no prostate cancer diagnosis by 72, were represented in two microsimulation models, which simulated individual health histories. The models compared continued screening at ages 72, 74 and 76 across groups with different levels of other illnesses.

The approaches used a prostate-specific antigen blood level of 6.5 nanograms per milliliter to trigger magnetic resonance imaging and targeted tissue sampling. Overdiagnosis meant finding a cancer that would not have been diagnosed during a man’s lifetime without screening. Estimated overdiagnoses per prostate cancer death prevented increased with age. This ratio was at least double in men with severe life-limiting illnesses compared with men of the same age without other illnesses.

Why it matters

For older men, the estimates could help guide decisions about when to stop prostate cancer screening.

Caveats

The estimates depended on assumptions about cancer progression and screening benefits. They represented men consistently screened from ages 50 to 70, so they may not apply to men with different screening histories.

Where the evidence stands

Magnetic resonance imaging

Mice and humans: a single group. Cells and worms or flies: nothing yet.

C, W, M, H: cells, worms or flies, mice, humans. Dark: independent labs found the same change there. Light: one lab or one study. Outline: nothing yet.

Labs are independent when their papers share no last author and no institution.

Against: findings that point the other way from most findings on the same outcome.

  • 9 independent labs in 7 countries
  • 2 findings against
  • Funders: Guangdong Medical Research Foundation and others

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