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Annual Prostate Cancer Screening Improves Quality-Adjusted Life Expectancy for High-Risk Patients Compared to Unscreened Patients

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BOSTON, Oct. 30, 2012 (GLOBE NEWSWIRE) -- Annual prostate-specific antigen (PSA) screening yields a greater quality-adjusted life expectancy (QALE) among patients who have a high-risk of developing metastatic disease in comparison to unscreened patients, according to research presented today at the American Society for Radiation Oncology's (ASTRO's) 54th Annual Meeting. In addition, a number of individual factors should be a part of the decision-making process about whether or not to regularly undergo PSA screening.

The study created a state transition Markov model to compare QALE in men with and without annual PSA screening in order to provide further guidance on screening and treatment decisions. In comparing screened versus non-screened patients, the study found a slight benefit to screening with a value of 13.70 quality-adjusted life years (QALYs) and 13.24 QALYs, respectively. However, the benefit of annual PSA screening diminished with increasing age and was dependent on the probability of eventually developing metastatic cancer and the associated decrease in quality of life. For patients who had less than a 4.9 percent chance of developing prostate cancer within 10 years, the recommended strategy was to forgo annual screening. The study indicates that factors contributing to whether or not a patient should be screened include the age and health of the patient and the potential impact of screening and a prostate cancer diagnosis on their quality of life.

The study, though independent from the European Randomized Study of Screening for Prostate Cancer (ERSPC), used findings from the ERSPC study published in The New England Journal of Medicine in 2009 and 2012 , which randomized approximately 162,000 men. Men aged 65 and older were included in the model, and the results from screening were tracked for 25 years. In men who screened positive for prostate cancer, the study assumed that they had clinically-localized, low-risk prostate cancer, and underwent treatment with intensity modulated radiation therapy (IMRT). In men not screened for prostate cancer who presented with localized disease, the study also assumed they had low-risk disease and underwent subsequent treatment with IMRT. Long-term treatment-related adverse effects included the possibility of developing genitourinary toxicity, gastrointestinal toxicity and sexual dysfunction.

"Our model suggests, that for certain subgroups of men, there may be a quality of life benefit from annual prostate cancer screening and subsequent treatment with radiation therapy," said Arie P. Dosoretz, MD, lead author of the study and a radiation oncologist at Yale-New Haven Hospital, in New Haven, Conn. "Decision-making about whether men should or should not be screened is complex and nuanced and should be made on an individual basis, with careful consideration of the patient's age, and the potential impact of diagnosis and treatment on their quality of life."

The abstract, "A Decision Analysis to Assess the Value of Prostate Cancer Screening: A Shift in Focus from Prostate Cancer Specific Mortality to Distant Metastasis Free Survival," will be presented in detail during a scientific session at ASTRO's 54th Annual Meeting at 1:15 p.m. – 2:45 p.m. Eastern time, on Tuesday, October, 30, 2012. To speak with Dr. Dosoretz, call Michelle Kirkwood on October 28-31, 2012, in the ASTRO Press Office at the Boston Convention and Exhibition Center at 617-954-3461 or 617-954-3462, or email michellek@astro.org.

ASTRO's 54th Annual Meeting, held in Boston, October 28 – 31, 2012, is the premier scientific meeting in radiation oncology and brings together more than 11,000 attendees including oncologists from all disciplines, medical physicists, dosimetrists, radiation therapists, radiation oncology nurses and nurse practitioners, biologists, physician assistants, practice administrators, industry representatives and other health care professionals from around the world. The theme of the 2012 Annual Meeting is "Advancing Patient Care through Innovation" and examines how innovation in technology and patient care delivery can lead to improved patient outcomes. The four-day scientific meeting includes six plenary papers and 410 oral presentations in 63 oral scientific sessions, and 1,724 posters and 130 digital posters in 18 tracks/topic areas.

ABOUT ASTRO

ASTRO is the largest radiation oncology society in the world, with more than 10,000 members who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, biology and physics, the Society is dedicated to improving patient care through education, clinical practice, advancement of science and advocacy. For more information on radiation therapy, visit www.rtanswers.org. To learn more about ASTRO, visit www.astro.org.

2012 American Society for Radiation Oncology (ASTRO) 54th Annual Meeting

News Briefing, Tuesday, October 30, 3:15 p.m. – 4:00 p.m. Eastern time

Scientific Session: Tuesday, October, 30, 2012, 1:15 – 3:00 p.m. Eastern time, Boston Convention & Exhibition Center

140 A Decision Analysis to Assess the Value of Prostate Cancer Screening: A Shift in Focus from Prostate Cancer Specific Mortality to Distant Metastasis Free Survival
A. P. Dosoretz1, N. H. Lester-Coll2, J. B. Yu1,3, 1Yale-New Haven Hospital, Department of Therapeutic Radiology, New Haven, CT, 2University of Pennsylvania, School of Medicine, Philadelphia, PA, 3Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER), New Haven, CT

Introduction: The US Preventive Services Task Force has recommended against prostate-specific antigen (PSA) screening for prostate cancer. The debate regarding PSA screening has centered on the indolent nature of prostate cancer, the lack of a proven mortality benefit specific to screening, and the potential for treatment related harm. We created a decision analytic model to calculate the quality-adjusted life expectancy (QALE) associated with screening men for prostate cancer with annual PSA testing in order to provide further guidance on screening and treatment decisions.

Methods: A state transition Markov model was constructed to compare QALE in men with and without annual PSA screening. Men entered the model at age 65 and exited after 25 years. In men screened positive for disease, after a confirmatory work-up, we assumed a presentation with clinically localized, low risk prostate cancer, and treatment with Intensity-Modulated Radiation Therapy (IMRT). In men not screened for prostate cancer that presented with localized disease, we also assumed a presentation with low-risk disease and subsequent treatment with IMRT. Probabilities associated with diagnosis and treatment response as well as the utility values for different health states, including living with distant metastatic disease and living with long-term treatment-related adverse effects, were derived from validated prospective studies. Long-term treatment-related adverse effects included the possibility of developing genitourinary toxicity, gastrointestinal toxicity, and sexual dysfunction.

Results: Annual PSA screening resulted in greater QALE compared to no PSA screening, producing 13.70 quality-adjusted life-years (QALYs) versus 13.24 QALYs, respectively. PSA screening yielded greater QALE for all patient ages versus no screening, although the incremental benefit of screening diminished with increasing age. One-way sensitivity analysis revealed that the model is most sensitive to the probability of developing metastatic disease. If the 10-year probability of developing metastatic disease in the unscreened group was below 4.9%, no screening became the preferred strategy.

Conclusion:  Our study found an improved QALE for men who underwent annual PSA screening compared to those who did not, with the exception of men with a very low risk of developing metastatic disease. This decision analysis suggests that the morbidity associated with a higher risk of developing metastatic disease outweighs the possibility of developing long-term treatment-related adverse effects when 65 year old men with average life expectancy and low-risk disease are treated with IMRT. Future decision making should account for individualized utilities and the economic costs associated with prostate cancer screening and treatment.

Author Disclosure Block:

A.P. Dosoretz: None. N.H. Lester-Coll: None. J.B. Yu: None.

CONTACT: Michelle Kirkwood, 703-286-1600, michellek@astro.org
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