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Gulati R, Jiao B, Al-Faouri R, Sharma V, Kaul S, Fleishman A, Wymer K, Boorjian SA, Olumi AF, Etzioni R, Gershman B. Lifetime Health and Economic Outcomes of Biparametric Magnetic Resonance Imaging as First-Line Screening for Prostate Cancer : A Decision Model Analysis. Ann Intern Med 2024; 177:871-881. [PMID: 38830219 DOI: 10.7326/m23-1504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Contemporary prostate cancer (PCa) screening uses first-line prostate-specific antigen (PSA) testing, possibly followed by multiparametric magnetic resonance imaging (mpMRI) for men with elevated PSA levels. First-line biparametric MRI (bpMRI) screening has been proposed as an alternative. OBJECTIVE To evaluate the comparative effectiveness and cost-effectiveness of first-line bpMRI versus PSA-based screening. DESIGN Decision analysis using a microsimulation model. DATA SOURCES Surveillance, Epidemiology, and End Results database; randomized trials. TARGET POPULATION U.S. men aged 55 years with no prior screening or PCa diagnosis. TIME HORIZON Lifetime. PERSPECTIVE U.S. health care system. INTERVENTION Biennial screening to age 69 years using first-line PSA testing (test-positive threshold, 4 µg/L) with or without second-line mpMRI or first-line bpMRI (test-positive threshold, PI-RADS [Prostate Imaging Reporting and Data System] 3 to 5 or 4 to 5), followed by biopsy guided by MRI or MRI plus transrectal ultrasonography. OUTCOME MEASURES Screening tests, biopsies, diagnoses, overdiagnoses, treatments, PCa deaths, quality-adjusted and unadjusted life-years saved, and costs. RESULTS OF BASE-CASE ANALYSIS For 1000 men, first-line bpMRI versus first-line PSA testing prevented 2 to 3 PCa deaths and added 10 to 30 life-years (4 to 11 days per person) but increased the number of biopsies by 1506 to 4174 and the number of overdiagnoses by 38 to 124 depending on the biopsy imaging scheme. At conventional cost-effectiveness thresholds, first-line PSA testing with mpMRI followed by either biopsy approach for PI-RADS 4 to 5 produced the greatest net monetary benefits. RESULTS OF SENSITIVITY ANALYSIS First-line PSA testing remained more cost-effective even if bpMRI was free, all men with low-risk PCa underwent surveillance, or screening was quadrennial. LIMITATION Performance of first-line bpMRI was based on second-line mpMRI data. CONCLUSION Decision analysis suggests that comparative effectiveness and cost-effectiveness of PCa screening are driven by false-positive results and overdiagnoses, favoring first-line PSA testing with mpMRI over first-line bpMRI. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Roman Gulati
- Fred Hutchinson Cancer Center, Seattle, Washington (R.G., R.E.)
| | - Boshen Jiao
- Fred Hutchinson Cancer Center and Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington (B.J.)
| | - Ra'ad Al-Faouri
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.A., A.F.O., B.G.)
| | - Vidit Sharma
- Mayo Clinic, Rochester, Minnesota (V.S., K.W., S.A.B.)
| | - Sumedh Kaul
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts (S.K., A.F.)
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts (S.K., A.F.)
| | - Kevin Wymer
- Mayo Clinic, Rochester, Minnesota (V.S., K.W., S.A.B.)
| | | | - Aria F Olumi
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.A., A.F.O., B.G.)
| | - Ruth Etzioni
- Fred Hutchinson Cancer Center, Seattle, Washington (R.G., R.E.)
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.A., A.F.O., B.G.)
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Jin D, Kong XQ, Zhu YJ, Chen ZX, Wang XM, Xu CH, Pu JX, Hou JQ, Huang YH, Ji FH, Huang C. Cost-effectiveness analysis of different anesthesia strategies for transperineal MRI/US fusion prostate biopsy. Asian J Androl 2024; 26:409-414. [PMID: 38376191 DOI: 10.4103/aja202385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/15/2023] [Indexed: 02/21/2024] Open
Abstract
This study aims to conduct a cost-effectiveness analysis of three different anesthesia strategies, namely chatting while under local anesthesia (Chat-LA), total intravenous anesthesia (TIVA), and general anesthesia with laryngeal mask airway (GA-LMA), employed in transperineal magnetic resonance imaging (MRI)/ultrasound (US) fusion prostate biopsy (TP-MUF-PB). A retrospective study was conducted involving 1202 patients who underwent TP-MUF-PB from June 2016 to April 2023 at The First Affiliated Hospital of Soochow University (Suzhou, China). Clinical data and outcomes, including total costs, complications, and quality-adjusted life years (QALYs), were compared. Probability sensitivity and subgroup analyses were also performed. Chat-LA was found to be the most cost-effective option, outperforming both TIVA and GA-LMA. However, subgroup analyses revealed that in younger patients (under 65 years old) and those with smaller prostate volumes (<40 ml), TIVA emerged as a more cost-effective strategy. While Chat-LA may generally be the most cost-effective and safer anesthesia method for TP-MUF-PB, personalization of anesthesia strategies is crucial, considering specific patient demographics such as age and prostate volume.
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Affiliation(s)
- Di Jin
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xiao-Qi Kong
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ya-Juan Zhu
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Zong-Xin Chen
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xi-Ming Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Cai-Hua Xu
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jin-Xian Pu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Urology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215000, China
| | - Jian-Quan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Urology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215000, China
| | - Yu-Hua Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Fu-Hai Ji
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Chen Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Dave P, Carlsson SV, Watts K. Randomized trials of PSA screening. Urol Oncol 2024:S1078-1439(24)00487-3. [PMID: 38926075 DOI: 10.1016/j.urolonc.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/02/2024] [Accepted: 05/18/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The role of prostate-specific antigen (PSA) testing in prostate cancer (PCa) screening has evolved over recent decades with multiple randomized controlled trials (RCTs) spurring guideline changes. At present, controversy exists due to the indolent nature of many prostate cancers and associated risks of overdiagnosis and overtreatment. This review examines major RCTs evaluating PSA screening to inform clinical practices. METHODS AND MATERIALS We summarize findings from primary RCTs investigating PSA screening's impact on PCa mortality and incidence: the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, the European Randomized Study of Screening for Prostate Cancer (ERSPC), and the Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP). RESULTS The PLCO Trial randomized men to annual PSA and DRE screening or usual care, reporting no significant difference in PCa mortality between groups at 17 years (RR 0.93, [95% CI: 0.81-1.08]), yet significantly increased detection and concomitant decreased detection in Gleason 6 (RR 1.17, [95% CI: 1.11-1.23]) and 8-10 disease (RR 0.89, [95% CI: 0.80-0.99]) in the screening group, respectively. The ESPRC Trial randomized men across seven European countries to PSA screening every 2-4 years or usual care, noting a 20% reduction in PCa mortality at 9 years (RR 0.81, [95% CI: 0.65-0.98]) and significant decrease in metastatic disease at 12 years (RR 0.70, [95% CI: 0.60-0.82]). The CAP Trial assessed a single PSA screening test's impact on PCa mortality yielding no significant difference in PCa mortality at 10 years (RR 0.96, [95% CI: 0.85-1.08]). Limitations amongst studies included high contamination between study arms and low compliance with study protocols. CONCLUSIONS While the CAP and initial PLCO trials showed no significant reduction in PCa mortality, the ERSPC demonstrated a 21% reduction at 13 years, with further benefits at extended follow-up. Differences in outcomes are attributed to variations in trial design, contamination, adherence rates, and PSA thresholds. Future studies are needed focus on optimizing screening intervals, targeting high-risk populations, and incorporating non-invasive diagnostic tools to improve screening efficacy and reduce associated harms.
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Affiliation(s)
- Priya Dave
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Sigrid V Carlsson
- Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Translational Medicine, Division of Urological Cancers, Medical Faculty, Lund University, Lund, Sweden
| | - Kara Watts
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
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4
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Pekala KR, Shill DK, Austria M, Langford AT, Loeb S, Carlsson SV. Shared decision-making before prostate cancer screening decisions. Nat Rev Urol 2024; 21:329-338. [PMID: 38168921 DOI: 10.1038/s41585-023-00840-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/05/2024]
Abstract
Decisions around prostate-specific antigen screening require a patient-centred approach, considering the benefits and risks of potential harm. Using shared decision-making (SDM) can improve men's knowledge and reduce decisional conflict. SDM is supported by evidence, but can be difficult to implement in clinical settings. An inclusive definition of SDM was used in order to determine the prevalence of SDM in prostate cancer screening decisions. Despite consensus among guidelines endorsing SDM practice, the prevalence of SDM occurring before the decision to undergo or forgo prostate-specific antigen testing varied between 11% and 98%, and was higher in studies in which SDM was self-reported by physicians than in patient-reported recollections and observed practices. The influence of trust and continuity in physician-patient relationships were identified as facilitators of SDM, whereas common barriers included limited appointment times and poor health literacy. Decision aids, which can help physicians to convey health information within a limited time frame and give patients increased autonomy over decisions, are underused and were not shown to clearly influence whether SDM occurs. Future studies should focus on methods to facilitate the use of SDM in clinical settings.
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Affiliation(s)
- Kelly R Pekala
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mia Austria
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aisha T Langford
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Stacy Loeb
- Department of Population Health, New York University, New York, NY, USA
- Department of Urology, New York University and Manhattan Veterans Affairs Medical Center, New York, NY, USA
| | - Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
- Department of Translational Medicine, Division of Urological Cancers, Medical Faculty, Lund University, Lund, Sweden.
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5
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Stucki M, Dosch S, Gnädinger M, Graber SM, Huber CA, Lenzin G, Strebel RT, Zwahlen DR, Omlin A, Wieser S. Real-world treatment patterns and medical costs of prostate cancer patients in Switzerland - A claims data analysis. Eur J Cancer 2024; 204:114072. [PMID: 38678761 DOI: 10.1016/j.ejca.2024.114072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Prostate cancer (PC) is the most prevalent cancer in men in Switzerland. However, evidence on the real-world health care use of PC patients is scarce. The aim of this study is to describe health care utilization, treatment patterns, and medical costs in PC patients over a period of five years (2014-2018). METHOD We used routinely collected longitudinal individual-level claims data from a major provider of mandatory health insurance in Switzerland. Due to the lack of diagnostic coding in the claims data, we identified treated PC patients based on the treatments received. We described health care utilization and treatment pathways for patients with localized and metastatic PC. Costs were calculated from a health care system perspective. RESULTS A total of 5591 PC patients met the inclusion criteria. Between 2014 and 2018, 1741 patients had outpatient radiotherapy for localized or metastatic PC and 1579 patients underwent radical prostatectomy. 3502 patients had an androgen deprivation therapy (ADT). 9.5% of these patients had a combination therapy with docetaxel, and 11.0% had a combination with abiraterone acetate. Docetaxel was the most commonly used chemotherapy (first-line; n = 413, 78.4% of all patients in chemotherapy). Total medical costs of PC in Switzerland were estimated at CHF 347 m (95% CI 323-372) in 2018. CONCLUSION Most PC patients in this study were identified based on the use of ADT. Medical costs of PC in Switzerland amounted to 0.45% of total health care spending in 2018. Treatment of metastatic PC accounted for about two thirds of spending.
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Affiliation(s)
- Michael Stucki
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland.
| | - Stephanie Dosch
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland; Helsana Group, Zurich, Switzerland
| | | | | | | | - Golda Lenzin
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland
| | - Räto T Strebel
- Kantonsspital Graubünden, Department of Urology, Chur, Switzerland
| | - Daniel R Zwahlen
- Kantonsspital Winterthur, Department of Radiation Oncology, Winterthur, Switzerland
| | - Aurelius Omlin
- Onkozentrum Zürich und Uroonkologisches Zentrum, Hirslanden Zürich, Zurich, Switzerland; Universität Zürich, Zurich, Switzerland
| | - Simon Wieser
- ZHAW Zurich University of Applied Sciences, School of Management and Law, Winterthur Institute of Health Economics, Winterthur, Switzerland
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6
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Garraway IP, Carlsson SV, Nyame YA, Vassy JL, Chilov M, Fleming M, Frencher SK, George DJ, Kibel AS, King SA, Kittles R, Mahal BA, Pettaway CA, Rebbeck T, Rose B, Vince R, Winn RA, Yamoah K, Oh WK. Prostate Cancer Foundation Screening Guidelines for Black Men in the United States. NEJM EVIDENCE 2024; 3:EVIDoa2300289. [PMID: 38815168 DOI: 10.1056/evidoa2300289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, we examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States. METHODS A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis. CONCLUSIONS These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.).
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Affiliation(s)
- Isla P Garraway
- Department of Urology, David Geffen School of Medicine, University of California and Department of Surgical and Perioperative Care, VA Greater Los Angeles Healthcare System, Los Angeles
| | - Sigrid V Carlsson
- Departments of Surgery and Epidemiology and Biostatistics, Urology Service, Memorial Sloan Kettering Cancer Center, New York
- Department of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, and Department of Translational Medicine, Division of Urological Cancers, Medical Faculty, Lund University, Lund, Sweden
| | - Yaw A Nyame
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle
- Department of Urology, University of Washington, Seattle
| | - Jason L Vassy
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Health Administration, Bedford and Boston
- Harvard Medical School and Brigham and Women's Hospital, Boston
| | - Marina Chilov
- Medical Library, Memorial Sloan Kettering Cancer Center, New York
| | - Mark Fleming
- Virginia Oncology Associates, US Oncology Network, Norfolk, VA
| | - Stanley K Frencher
- Martin Luther King Jr. Community Hospital and University of California, Los Angeles
| | - Daniel J George
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | - Adam S Kibel
- Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Sherita A King
- Section of Urology, Medical College of Georgia at Augusta University and Charlie Norwood Veterans Affairs Medical Center, Augusta, GA
| | - Rick Kittles
- Morehouse School of Medicine, Community Health and Preventive Medicine, Atlanta
| | - Brandon A Mahal
- Sylvester Comprehensive Cancer Center, Miami
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami
| | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston
| | - Timothy Rebbeck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
- Harvard T.H. Chan School of Public Health, Boston
| | - Brent Rose
- Department of Radiation Oncology, University of California, San Diego
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Randy Vince
- Department of Urology, University of Michigan, Ann Arbor
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond
- Department of Internal Medicine, Virginia Commonwealth University, Richmond
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
- James A. Haley Veterans' Hospital, Tampa, FL
| | - William K Oh
- Prostate Cancer Foundation, Santa Monica, CA
- Division of Hematology and Medical Oncology, Tisch Cancer Institute at Mount Sinai, New York
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7
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Orbe Villota PM, Leiva Centeno JA, Lugones J, Minuzzi PG, Varea SM. Comparison between the European Randomized Study for Screening of Prostate Cancer (ERSPC) and Prostate Biopsy Collaborative Group (PBCG) risk calculators: Prediction of clinically significant Prostate Cancer risk in a cohort of patients from Argentina. Actas Urol Esp 2024; 48:210-217. [PMID: 37827241 DOI: 10.1016/j.acuroe.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To compare the performance of the risk calculators of the European Randomized Study for Screening of Prostate Cancer (ERSPC) and the Prostate Biopsy Collaborative Group (PBCG) in predicting the risk of presenting clinically significant prostate cancer. MATERIAL AND METHODS Retrospectively, patients who underwent prostate biopsy at Sanatorio Allende Cerro, Ciudad de Córdoba, Argentina, were identified from January 2018 to December 2021. The probability of having prostate cancer was calculated with the two calculators separately and then the results were compared to establish which of the two performed better. For this, areas under the curve (AUC) were analyzed. RESULTS 250 patients were included, 140 (56%) presented prostate cancer, of which 92 (65.71%) had clinically significant prostate cancer (Gleason score ≥7). The patients who presented cancer were older, had a higher prostate-specific antigen (PSA) value, and had a smaller prostate size. The AUC to predict the probability of having clinically significant prostate cancer was 0.79 and 0.73 for PBCG-RC and ERSPC-RC respectively (P=0.0084). CONCLUSION In this cohort of patients, both prostate cancer risk calculators performed well in predicting clinically significant prostate cancer risk, although the PBCG-RC showed better accuracy.
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Affiliation(s)
| | | | - J Lugones
- Servicio de Diagnóstico por Imágenes, Sanatorio Allende, Córdoba, Argentina
| | - P G Minuzzi
- Servicio de Urología, Sanatorio Allende, Córdoba, Argentina
| | - S M Varea
- Servicio de Urología, Sanatorio Allende, Córdoba, Argentina
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Carlsson SV, Preston MA, Vickers A, Malhotra D, Ehdaie B, Healey MJ, Kibel AS. A Provider-Facing Decision Support Tool for Prostate Cancer Screening in Primary Care: A Pilot Study. Appl Clin Inform 2024; 15:274-281. [PMID: 38599618 PMCID: PMC11006556 DOI: 10.1055/s-0044-1780511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/19/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES Our objective was to pilot test an electronic health record-embedded decision support tool to facilitate prostate-specific antigen (PSA) screening discussions in the primary care setting. METHODS We pilot-tested a novel decision support tool that was used by 10 primary care physicians (PCPs) for 6 months, followed by a survey. The tool comprised (1) a risk-stratified algorithm, (2) a tool for facilitating shared decision-making (Simple Schema), (3) three best practice advisories (BPAs: <45, 45-75, and >75 years), and (4) a health maintenance module for scheduling automated reminders about PSA rescreening. RESULTS All PCPs found the tool feasible, acceptable, and clear to use. Eight out of ten PCPs reported that the tool made PSA screening conversations somewhat or much easier. Before using the tool, 70% of PCPs felt confident in their ability to discuss PSA screening with their patient, and this improved to 100% after the tool was used by PCPs for 6 months. PCPs found the BPAs for eligible (45-75 years) and older men (>75 years) more useful than the BPA for younger men (<45 years). Among the 10 PCPs, 60% found the Simple Schema to be very useful, and 50% found the health maintenance module to be extremely or very useful. Most PCPs reported the components of the tool to be at least somewhat useful, with 10% finding them to be very burdensome. CONCLUSION We demonstrated the feasibility and acceptability of the tool, which is notable given the marked low acceptance of existing tools. All PCPs reported that they would consider continuing to use the tool in their clinic and were likely or very likely to recommend the tool to a colleague.
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Affiliation(s)
- Sigrid V. Carlsson
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Division of Urological Cancers, Department of Translational Medicine, Medical Faculty, Lund University, Lund, Sweden
| | - Mark A. Preston
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Deepak Malhotra
- Negotiation, Organizations, and Markets Unit, Harvard Business School, Boston, Massachusetts, United States
| | - Behfar Ehdaie
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Michael J. Healey
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Adam S. Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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9
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Yang Z, Heijnsdijk EAM, Newcomb LF, Rizopoulos D, Erler NS. Exploring the relation of active surveillance schedules and prostate cancer mortality. Cancer Med 2024; 13:e6977. [PMID: 38491826 PMCID: PMC10943374 DOI: 10.1002/cam4.6977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Active surveillance (AS), where treatment is deferred until cancer progression is detected by a biopsy, is acknowledged as a way to reduce overtreatment in prostate cancer. However, a consensus on the frequency of taking biopsies while in AS is lacking. In former studies to optimize biopsy schedules, the delay in progression detection was taken as an evaluation indicator and believed to be associated with the long-term outcome, prostate cancer mortality. Nevertheless, this relation was never investigated in empirical data. Here, we use simulated data from a microsimulation model to fill this knowledge gap. METHODS In this study, the established MIcrosimulation SCreening Analysis model was extended with functionality to simulate the AS procedures. The biopsy sensitivity in the model was calibrated on the Canary Prostate Cancer Active Surveillance Study (PASS) data, and four (tri-yearly, bi-yearly, PASS, and yearly) AS programs were simulated. The relation between detection delay and prostate cancer mortality was investigated by Cox models. RESULTS The biopsy sensitivity of progression detection was found to be 50%. The Cox models show a positive relation between a longer detection delay and a higher risk of prostate cancer death. A 2-year delay resulted in a prostate cancer death risk of 2.46%-2.69% 5 years after progression detection and a 10-year risk of 5.75%-5.91%. A 4-year delay led to an approximately 8% greater 5-year risk and an approximately 25% greater 10-year risk. CONCLUSION The detection delay is confirmed as a surrogate for prostate cancer mortality. A cut-off for a "safe" detection delay could not be identified.
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Affiliation(s)
- Zhenwei Yang
- Department of BiostatisticsErasmus University Medical CenterRotterdamthe Netherlands
- Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
| | | | - Lisa F. Newcomb
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer CenterSeattleWashingtonUSA
| | - Dimitris Rizopoulos
- Department of BiostatisticsErasmus University Medical CenterRotterdamthe Netherlands
- Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
| | - Nicole S. Erler
- Department of BiostatisticsErasmus University Medical CenterRotterdamthe Netherlands
- Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
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Peyrottes A, Rouprêt M, Fiard G, Fromont G, Barret E, Brureau L, Créhange G, Gauthé M, Baboudjian M, Renard-Penna R, Roubaud G, Rozet F, Sargos P, Ruffion A, Mathieu R, Beauval JB, De La Taille A, Ploussard G, Dariane C. [Early detection of prostate cancer: Towards a new paradigm?]. Prog Urol 2023; 33:956-965. [PMID: 37805291 DOI: 10.1016/j.purol.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/12/2023] [Indexed: 10/09/2023]
Abstract
Prostate cancer (PCa) is a public health issue. The diagnostic strategy for PCa is well codified and assessed by digital rectal examination, PSA testing and multiparametric MRI, which may or may not lead to prostate biopsies. The formal benefit of organized PCa screening, studied more than 10 years ago at an international scale and for all incomers, is not demonstrated. However, diagnostic and therapeutic modalities have evolved since the pivotal studies. The contribution of MRI and targeted biopsies, the widespread use of active surveillance for unsignificant PCa, the improvement of surgical techniques and radiotherapy… have allowed a better selection of patients and strengthened the interest for an individualized approach, reducing the risk of overtreatment. Aiming to enhance coverage and access to screening for the population, the European Commission recently promoted the evaluation of an organized PCa screening strategy, including MRI. The lack of screening programs has become detrimental to the population and must shift towards an early detection policy adapted to the risk of each individual.
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Affiliation(s)
- A Peyrottes
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, membre junior, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, 20 rue Leblanc, 75015 Paris, France.
| | - M Rouprêt
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne university, GRC 5 Predictive Onco-Uro, AP-HP, urology, Pitié-Salpétrière hospital, 75013 Paris, France
| | - G Fiard
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, Grenoble Alpes university hospital, université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - G Fromont
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of pathology, CHRU, 37000 Tours, France
| | - E Barret
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, institut mutualiste Montsouris, Paris, France
| | - L Brureau
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, CHU de Pointe-à-Pitre, university of Antilles, university of Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR S 1085, 97110 Pointe-à-Pitre, Guadeloupe
| | - G Créhange
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of radiotherapy, institut Curie, Paris, France
| | - M Gauthé
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sintep nuclear medicine, 38100 Grenoble, France
| | - M Baboudjian
- Department of urology, La Conception Hospital, Aix-Marseille University, AP-HM, Marseille, France
| | - R Renard-Penna
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne university, AP-HP, radiology, Pitie-Salpétrière hospital, 75013 Paris, France
| | - G Roubaud
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of medical oncology, institut Bergonié, 33000 Bordeaux, France
| | - F Rozet
- Sorbonne university, GRC 5 Predictive Onco-Uro, AP-HP, urology, Pitié-Salpétrière hospital, 75013 Paris, France; Department of urology, institut mutualiste Montsouris, Paris, France
| | - P Sargos
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of radiotherapy, institut Bergonié, 33000 Bordeaux, France
| | - A Ruffion
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, centre hospitalier Lyon Sud, hospices civils de Lyon, Lyon, France
| | - R Mathieu
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, CHU de Rennes, Rennes, France
| | - J-B Beauval
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, La Croix du Sud Hôpital, Quint-Fonsegrives, France
| | - A De La Taille
- Department of urology, university hospital Henri-Mondor, AP-HP, Créteil, France
| | - G Ploussard
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, La Croix du Sud Hôpital, Quint-Fonsegrives, France
| | - C Dariane
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, 20 rue Leblanc, 75015 Paris, France
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Hussein AA, Shabir U, Mahmood AW, Harrington G, Khan M, Ahmad A, Howlader M, Colan N, Shah AA, Ghadersohi S, Jing Z, Xu B, Sule N, Kauffman E, Kuettel M, Guru K. The impact of NCCN-compliant multidisciplinary conference on the uptake of active surveillance among eligible patients with localized prostate cancer. Urol Oncol 2023; 41:483.e21-483.e26. [PMID: 37945390 DOI: 10.1016/j.urolonc.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION We sought to investigate the impact of National Comprehensive Cancer Network (NCCN)-compliant multidisciplinary conference on the uptake of active surveillance (AS) among eligible patients with prostate cancer. METHODS Retrospective review of our AS database was performed. Patients who are eligible for AS who sought a second opinion at a comprehensive cancer center (2010-2021) were presented to the multidisciplinary Localized Prostate Cancer Conference (LPCC) that includes urologists, radiation oncologists, pathologists, and patient advocates. Cochrane Armitage test was used to examine trends over time. Multivariable regression models were fit to evaluate variables associated with the receipt of AS. RESULTS Seven hundred twelve patients were identified (19% NCCN very low risk, 32% low risk, and 49% intermediate favorable risk). 43% were recommended AS as the preferred option by the community compared to 68% by LPCC, and 65% elected AS. Recommending AS significantly increased between 2010 and 2021 by the community (from 26% to 57%) and by LPCC (from 52% to 82%), while the proportion of men who received AS increased from 47% to 80% during the same period (P < 0.0001 for all). More recent LPCC era 2017 to 2021 (OR 12.31, 95% CI, 5.60-27.03, P < 0.0001), African American race (OR 0.42, 95% CI, 0.18-0.96, P = 0.04), positive cores at biopsy (OR 0.96, 95% CI, 0.94-0.97, P < 0.0001), age (OR 1.14, 95% CI, 1.10-1.18, P < 0.0001), NCCN low risk (OR 0.25, 95% CI, 0.08-0.81, P = 0.02) and NCCN intermediate favorable risk (OR 0.03, 95% CI, 0.01-0.09, P < 0.0001) were associated with receipt of AS. CONCLUSION AS recommendation increased significantly over time by community urologists and to a higher extent by NCCN-compliant multidisciplinary conference. The Uptake of AS significantly increased within the same period. More recent LPCC era 2017 to 2021, African American race, the proportion of positive cores at biopsy, age, and NCCN risk were the main determinants of receipt of AS.
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Affiliation(s)
- Ahmed A Hussein
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Usma Shabir
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Abdul Wasay Mahmood
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Grace Harrington
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Mohammad Khan
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Ali Ahmad
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Muhsinah Howlader
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Nicholas Colan
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Ayat A Shah
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Sarah Ghadersohi
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Zhe Jing
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Bo Xu
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Nobert Sule
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Eric Kauffman
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Michael Kuettel
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Khurshid Guru
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY.
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12
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Mohamadkhani N, Nahvijou A, Hadian M. Optimal age to stop prostate cancer screening and early detection. J Cancer Policy 2023; 38:100443. [PMID: 37598870 DOI: 10.1016/j.jcpo.2023.100443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Prostate Cancer screening should be discontinued at older ages because competing mortality risks eventually dominate the risk of Prostate Cancer and harms exceed benefits. We explored the Prostate Cancer screening stopping age from the patient, healthcare system, and social perspectives in Iran. METHODS We applied Bellman Equations to formulate the net benefits biopsy and "do nothing". Using difference between the net benefits of two alternatives, we calculated the stopping age. The cancer states were without cancer, undetected cancer, detected cancer, metastatic cancer, and death. To move between states, we applied Markov property. Transition probabilities, rewards, and costs were inferred from the medical literature. The base-case scenario estimated the stopping age from the patient, healthcare system, and social perspectives. A one-way sensitivity used to find the most influential parameters on the stopping age. RESULTS Our results suggested that Prostate Cancer screening stopping ages from the patient, healthcare system, and social were 70, 68, and 68 respectively. The univariate sensitivity analysis showed that the stopping ages were sensitive to the disutility of treatment, discount factor, the disutility of metastasis, the annual probability of death from other causes, and the annual probability of developing metastasis from the hidden cancer state. CONCLUSIONS Men should not be screened for Prostate Cancer beyond 70 years old, as this results in the net benefit of "do nothing" above the biopsy. Nevertheless, this finding needs to be further studied with more detailed cancer progression models (considering re-biopsy, comorbidities, and more complicated states transition) and using local utility and willingness to pay value information.
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Affiliation(s)
- Naser Mohamadkhani
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center of Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
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Scholte M, Heidkamp J, Hannink G, Merkx MAWT, Grutters JPC, Rovers MM. Care Pathway Analysis to Inform the Earliest Stages of Technology Development: Scoping Oncological Indications in Need of Innovation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1744-1753. [PMID: 37757910 DOI: 10.1016/j.jval.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVES Identifying unmet needs for innovative solutions across disease contexts is challenging but important for directing funding and research efforts and informing early-stage decisions during the innovation process. Our aim was to study the merits of care pathway analysis to scope disease contexts and guide the development of innovative devices. We used oncologic surgery as a case study, for which many intraoperative imaging techniques are under development. METHODS Care pathway analysis is a mapping process, which produces graphical maps of clinical pathways using important outcomes and subsequent consequences. We performed care pathway analyses for glioblastoma, breast, bladder, prostate, renal, pancreatic, and oral cavity cancer. Differences between a "perfect" care pathway and the current care pathway in terms of percentage of inadequate margins, associated recurrences, quality of life, and 5-year overall survival were calculated to determine unmet needs. Data from The Netherlands Cancer Registry and literature were used. RESULTS Care pathway analysis showed that highest percentages of inadequate margins were found in oral cavity cancer (72.5%), glioblastoma (48.7%), and pancreatic cancer (43.9%). Inadequate margins showed the strongest increase in recurrences in cancer of oral cavity, and bladder (absolute increases of 43.5% and 41.2%, respectively). Impact on survival was largest for bladder and oral cavity cancer with positive margins. CONCLUSIONS Care pathway analysis provides overviews of current clinical paths in multiple indications. Disease contexts can be compared via effectiveness gaps that show the potential need for innovative solutions. This information can be used as basis for stakeholder involvement processes to prioritize care pathways in need of innovation.
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Affiliation(s)
- Mirre Scholte
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Imaging, Nijmegen, The Netherlands; Maastricht University Medical Centre+, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht, The Netherlands.
| | - Jan Heidkamp
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Imaging, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Imaging, Nijmegen, The Netherlands
| | - M A W Thijs Merkx
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (Integraal Kankercentrum Nederland, IKNL), Utrecht, The Netherlands; Dutch Rare Cancer Platform, The Netherlands; IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janneke P C Grutters
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Imaging, Nijmegen, The Netherlands
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Qian C, Zou X, Li W, Li Y, Yu W. The outpost against cancer: universal cancer only markers. Cancer Biol Med 2023; 20:j.issn.2095-3941.2023.0313. [PMID: 38018033 PMCID: PMC10690883 DOI: 10.20892/j.issn.2095-3941.2023.0313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/12/2023] [Indexed: 11/30/2023] Open
Abstract
Cancer is the leading cause of death worldwide. Early detection of cancer can lower the mortality of all types of cancer; however, effective early-detection biomarkers are lacking for most types of cancers. DNA methylation has always been a major target of interest because DNA methylation usually occurs before other detectable genetic changes. While investigating the common features of cancer using a novel guide positioning sequencing for DNA methylation, a series of universal cancer only markers (UCOMs) have emerged as strong candidates for effective and accurate early detection of cancer. While the clinical value of current cancer biomarkers is diminished by low sensitivity and/or low specificity, the unique characteristics of UCOMs ensure clinically meaningful results. Validation of the clinical potential of UCOMs in lung, cervical, endometrial, and urothelial cancers further supports the application of UCOMs in multiple cancer types and various clinical scenarios. In fact, the applications of UCOMs are currently under active investigation with further evaluation in the early detection of cancer, auxiliary diagnosis, treatment efficacy, and recurrence monitoring. The molecular mechanisms by which UCOMs detect cancers are the next important topics to be investigated. The application of UCOMs in real-world scenarios also requires implementation and refinement.
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Affiliation(s)
- Chengchen Qian
- Shanghai Epiprobe Biotechnology Co., Ltd, Shanghai 200233, China
| | - Xiaolong Zou
- Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Wei Li
- Shanghai Epiprobe Biotechnology Co., Ltd, Shanghai 200233, China
- Shandong Epiprobe Medical Laboratory Co., Ltd, Heze 274108, China
| | - Yinshan Li
- People’s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan 750002, China
| | - Wenqiang Yu
- Shanghai Public Health Clinical Center & Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute & Laboratory of RNA Epigenetics, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Yun H, Kim J, Gandhe A, Nelson B, Hu JC, Gulani V, Margolis D, Schackman BR, Jalali A. Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results. JAMA Netw Open 2023; 6:e2344856. [PMID: 38019516 PMCID: PMC10687655 DOI: 10.1001/jamanetworkopen.2023.44856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/13/2023] [Indexed: 11/30/2023] Open
Abstract
Importance Magnetic resonance imaging (MRI) and potential MRI-guided biopsy enable enhanced identification of clinically significant prostate cancer. Despite proven efficacy, MRI and potential MRI-guided biopsy remain costly, and there is limited evidence regarding the cost-effectiveness of this approach in general and for different prostate-specific antigen (PSA) strata. Objective To examine the cost-effectiveness of integrating annual MRI and potential MRI-guided biopsy as part of clinical decision-making for men after being screened for prostate cancer compared with standard biopsy. Design, Setting, and Participants Using a decision analytic Markov cohort model, an economic evaluation was conducted projecting outcomes over 10 years for a hypothetical cohort of 65-year-old men in the US with 4 different PSA strata (<2.5 ng/mL, 2.5-4.0 ng/mL, 4.1-10.0 ng/mL, >10 ng/mL) identified by screening through Monte Carlo microsimulation with 10 000 trials. Model inputs for probabilities, costs in 2020 US dollars, and quality-adjusted life-years (QALYs) were from the literature and expert consultation. The model was specifically designed to reflect the US health care system, adopting a federal payer perspective (ie, Medicare). Exposures Magnetic resonance imaging with potential MRI-guided biopsy and standard biopsy. Main Outcomes and Measures Incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $100 000 per QALY was estimated. One-way and probabilistic sensitivity analyses were performed. Results For the 3 PSA strata of 2.5 ng/mL or greater, the MRI and potential MRI-guided biopsy strategy was cost-effective compared with standard biopsy (PSA 2.5-4.0 ng/mL: base-case ICER, $21 131/QALY; PSA 4.1-10.0 ng/mL: base-case ICER, $12 336/QALY; PSA >10.0 ng/mL: base-case ICER, $6000/QALY). Results varied depending on the diagnostic accuracy of MRI and potential MRI-guided biopsy. Results of probabilistic sensitivity analyses showed that the MRI and potential MRI-guided biopsy strategy was cost-effective at the willingness-to-pay threshold of $100 000 per QALY in a range between 76% and 81% of simulations for each of the 3 PSA strata of 2.5 ng/mL or more. Conclusions and Relevance This economic evaluation of a hypothetical cohort suggests that an annual MRI and potential MRI-guided biopsy was a cost-effective option from a US federal payer perspective compared with standard biopsy for newly eligible male Medicare beneficiaries with a serum PSA level of 2.5 ng/mL or more.
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Affiliation(s)
- Hyunkyung Yun
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Jin Kim
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York
| | - Aishwarya Gandhe
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York
| | - Brianna Nelson
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York
| | - Jim C. Hu
- Department of Urology, Weill Cornell Medicine, Cornell University, New York, New York
| | - Vikas Gulani
- Department of Radiology, University of Michigan Health System, Ann Arbor
| | - Daniel Margolis
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, New York
| | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York
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16
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Mohammadi T, Guh DP, Tam ACT, Pataky RE, Black PC, So A, Lynd LD, Zhang W, Conklin AI. Economic evaluation of prostate cancer risk assessment methods: A cost-effectiveness analysis using population data. Cancer Med 2023; 12:20106-20118. [PMID: 37740609 PMCID: PMC10587968 DOI: 10.1002/cam4.6587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND The current prostate cancer (PCa) screening standard of care (SOC) leads to unnecessary biopsies and overtreatment because decisions are guided by prostate-specific antigen (PSA) levels, which have low specificity in the gray zone (3-10 ng/mL). New risk assessment tools (RATs) aim to improve biopsy decision-making. We constructed a modeling framework to assess new RATs in men with gray zone PSA from the British Columbia healthcare system's perspective. METHODS We evaluated the cost-effectiveness of a new RAT used in biopsy-naïve men aged 50+ with a PSA of 3-10 ng/mL using a time-dependent state-transition model. The model was informed by engaging patient partners and using linked administrative health data, supplemented with published literature. The incremental cost-effectiveness ratio and the probability of the RAT being cost-effective were calculated. Probabilistic analysis was used to assess parameter uncertainty. RESULTS In the base case, a RAT based on an existing biomarker's characteristics was a dominant strategy associated with a cost savings of $44 and a quality-adjusted life years (QALY) gain of 0.00253 over 18 years of follow-up. At a cost-effectiveness threshold of $50,000/QALY, the probability that using a RAT is cost-effective relative to the SOC was 73%. Outcomes were sensitive to RAT costs and accuracy, especially the detection rate of high-grade PCa. Results were also impacted by PCa prevalence and assumptions about undetected PCa survival. CONCLUSIONS Our findings showed that a more accurate RAT to guide biopsy can be cost-effective. Our proposed general model can be used to analyze the cost-effectiveness of any novel RAT.
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Affiliation(s)
- Tima Mohammadi
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Daphne P. Guh
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Alexander C. T. Tam
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Reka E. Pataky
- Canadian Centre for Applied Research in Cancer Control, BC CancerVancouverBritish ColumbiaCanada
| | - Peter C. Black
- Department of Urologic Sciences, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Alan So
- Department of Urologic Sciences, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Larry D. Lynd
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Wei Zhang
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Annalijn I. Conklin
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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Hogenhout R, Remmers S, van Slooten-Midderigh ME, de Vos II, Roobol MJ. From Screening to Mortality Reduction: An Overview of Empirical Data on the Patient Journey in European Randomized Study of Screening for Prostate Cancer Rotterdam After 21 Years of Follow-up and a Reflection on Quality of Life. Eur Urol Oncol 2023:S2588-9311(23)00172-4. [PMID: 37690917 DOI: 10.1016/j.euo.2023.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/13/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Previous research quantified the effect of prostate-specific antigen (PSA)-based prostate cancer (PCa) screening on quality-adjusted life years using 11-yr follow-up data from the European Randomized Study of Screening for Prostate Cancer (ERSPC) extrapolated by the Microsimulation Screening Analysis (MISCAN). ERSPC data now matured to 21 yr of follow-up. OBJECTIVE To provide an overview of the effect of PSA-based screening on tumour characteristics and PCa treatment using long-term, detailed, empirical ERSPC data. DESIGN, SETTING, AND PARTICIPANTS Men were included from the ERSPC Rotterdam who were randomised to a PSA-based screening (S) or control (C) arm. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We assessed the effects of PSA-based screening on the number of PCa diagnoses, tumour characteristics, treatments, and cumulative incidence of disease progression. We also evaluated the changes in tumour characteristics and treatments over time for both study arms. RESULTS AND LIMITATIONS Among PCa patients in the S-arm, fewer patients were diagnosed with advanced tumour stages (T3/T4: 12% vs 23%; relative risk [RR] = 0.50; 95% confidence interval [CI] 0.44-0.57), less disease progression was observed, and less secondary treatment (30% vs 48%; RR = 0.61; 95% CI 0.57-0.66; p < 0.001) and less palliative treatment were needed (21% vs 55%; RR = 0.38; 95% CI 0.35-0.42) than among those in the C-arm. This was at the cost of overdiagnosis and increased local treatments (eg, radical prostatectomy: 32% vs 14%; RR = 2.18; 95% CI 1.92-2.48). Over time, the number of local treatments decreased, whereas expectant management strategies increased. The RRs of treatments were slightly different from those of the MISCAN. CONCLUSIONS After 21 yr of follow-up, empirical data of the ERSPC showed that PSA-based screening reduces advanced PCa stages, disease progression, and extensive treatments at the cost of more overdiagnosis and probably more overtreatment. Our data showed reduced local treatments and increased expectant management strategies over time. PATIENT SUMMARY Prostate-specific antigen-based screening reduces the number of invasive prostate cancer treatments needed, however, at the cost of more overdiagnosis and probably more overtreatment. Limiting these costs remains crucial to benefit optimally from prostate cancer screening.
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Affiliation(s)
- Renée Hogenhout
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Ivo I de Vos
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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18
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Wei JT, Barocas D, Carlsson S, Coakley F, Eggener S, Etzioni R, Fine SW, Han M, Kim SK, Kirkby E, Konety BR, Miner M, Moses K, Nissenberg MG, Pinto PA, Salami SS, Souter L, Thompson IM, Lin DW. Early Detection of Prostate Cancer: AUA/SUO Guideline Part I: Prostate Cancer Screening. J Urol 2023; 210:46-53. [PMID: 37096582 PMCID: PMC11060750 DOI: 10.1097/ju.0000000000003491] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The summary presented herein covers recommendations on the early detection of prostate cancer and provides a framework to facilitate clinical decision-making in the implementation of prostate cancer screening, biopsy, and follow-up. This is Part I of a two-part series that focuses on prostate cancer screening. Please refer to Part II for discussion of initial and repeat biopsies as well as biopsy technique. MATERIALS AND METHODS The systematic review utilized to inform this guideline was conducted by an independent methodological consultant. The systematic review was based on searches in Ovid MEDLINE and Embase and Cochrane Database of Systematic Reviews (January 1, 2000-November 21, 2022). Searches were supplemented by reviewing reference lists of relevant articles. RESULTS The Early Detection of Prostate Cancer Panel developed evidence- and consensus-based guideline statements to provide guidance in prostate cancer screening, initial and repeat biopsy, and biopsy technique. CONCLUSIONS Prostate-specific antigen (PSA)-based prostate cancer screening in combination with shared decision-making (SDM) is recommended. Current data regarding risk from population-based cohorts provide a basis for longer screening intervals and tailored screening, and the use of available online risk calculators is encouraged.
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Affiliation(s)
- John T Wei
- University of Michigan, Ann Arbor, Michigan
| | | | | | | | | | - Ruth Etzioni
- Fred Hutchinson Cancer Center, Seattle, Washington
| | - Samson W Fine
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Misop Han
- Johns Hopkins University, Baltimore, Maryland
| | - Sennett K Kim
- American Urological Association, Linthicum, Maryland
| | - Erin Kirkby
- American Urological Association, Linthicum, Maryland
| | | | | | | | - Merel G Nissenberg
- National Alliance of State Prostate Cancer Coalitions, Los Angeles, California
| | | | | | - Lesley Souter
- Nomadic EBM Methodology, Smithville, Ontario, Canada
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19
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Hudnut AG, Hubbell E, Venn O, Church TR. Modeled residual current cancer risk after clinical investigation of a positive multicancer early detection test result. Cancer 2023; 129:2056-2063. [PMID: 36943898 DOI: 10.1002/cncr.34747] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND Positive results of a multi-cancer early detection (MCED) test require confirmatory diagnostic workup. Here, residual current cancer risk (RR) during the process of diagnostic resolution, including situations where the initial confirmatory test does not provide resolution, was modeled. METHODS A decision-tree framework was used to model conditional risk in a patient's journey through confirmatory diagnostic options and outcomes. The diagnostic journey assumed that cancer signal detection (a positive MCED test result) had already led to a transition from screening to diagnosis and began with an initial positive predictive value (PPV) from the positive result. Evaluation of a most probable (top) predicted cancer signal origin (CSO) and then a second-most probable predicted CSO followed. Under the assumption that the top- and second-predicted CSOs were each followed by a targeted confirmatory test, the RR was estimated for each subsequent scenario. RESULTS For an initial MCED test result with typical performance characteristics modeled (PPV, 40%; top-predicted CSO accuracy, 90%), after a negative initial confirmatory test (sensitivity, 70%, 90%, or 100%) the RR ranged from 6% to 20%. A second-predicted CSO (accuracy, 50%), after a negative second confirmatory test, still provided a significant RR (3%-18%) in comparison with the National Institute for Health and Care Excellence-recommended cancer risk threshold warranting investigation in symptomatic individuals (3%). With a 40% PPV for an MCED test and 90% specificity for a confirmatory test, the risk of incidental findings after one or two confirmatory tests was 6% and 12%, respectively. CONCLUSIONS These results may illustrate the impact of a positive MCED test on follow-up decision-making.
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Affiliation(s)
- Andrew G Hudnut
- Family Medicine, Sutter Medical Group, Elk Grove, California, USA
| | - Earl Hubbell
- GRAIL, LLC, a subsidiary of Illumina, Inc., Menlo Park, California, USA
| | - Oliver Venn
- GRAIL, LLC, a subsidiary of Illumina, Inc., Menlo Park, California, USA
| | - Timothy R Church
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, USA
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20
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Maas CC, van Klaveren D, Visser O, Merkx MA, Lingsma HF, Lemmens VE, Dinmohamed AG. Number of life-years lost at the time of diagnosis and several years post-diagnosis in patients with solid malignancies: a population-based study in the Netherlands, 1989-2019. EClinicalMedicine 2023; 60:101994. [PMID: 37214634 PMCID: PMC10196760 DOI: 10.1016/j.eclinm.2023.101994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023] Open
Abstract
Background Loss of life expectancy (LOLE) may provide more intuitive information on the impact of cancer than relative survival over a fixed time horizon (e.g., 5-year relative survival). We aimed to assess the evolution of the LOLE using a nationwide, population-based cohort including patients diagnosed with one of 17 most frequent solid malignancies. Methods From the Netherlands Cancer Registry, we selected adult patients diagnosed with one of the 17 most frequent solid malignancies in the Netherlands during 1989-2019, with survival follow-up until 2022. We used flexible parametric survival models to estimate the LOLE at diagnosis and the LOLE after surviving several years post-diagnosis (conditional LOLE; CLOLE) by cancer type, calendar year, age, sex, and disease stage. Findings For all cancers combined, the LOLE consistently decreased from 1989 to 2019. This decrease was most pronounced for males with prostate cancer (e.g., from 6.9 [95% confidence interval [CI], 6.7-7.1] to 2.7 [95% CI, 2.5-3.0] for 65-year-olds) and females with breast cancer (e.g., from 6.6 [95% CI, 6.4-6.7] to 1.9 [95% CI, 1.8-2.0] for 65-year-olds). The LOLE among patients with cancers of the head and neck or the central nervous system remained constant over time. Overall, the CLOLE showed that the life years lost among patients with cancer decreased with each additional year survived post-diagnosis. For example, the LOLE at diagnosis for 65-year-old females diagnosed with breast cancer in 2019 was 1.9 [95% CI, 1.8-2.0] compared with 1.7 [95% CI, 1.6-1.8], 1.0 [95% CI, 0.9-1.1], and 0.5 [95% CI, 0.5-0.6] when surviving one, five, and ten years post-diagnosis, respectively. Estimates for other combinations of patient and tumour characteristics are available in a publicly available web-based application. Interpretation Our findings suggested that the evolution of LOLE substantially varies across cancer type, age, and disease stage. LOLE estimates help patients better understand the impact of their specific cancer diagnosis on their life expectancy. Funding None.
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Affiliation(s)
- Carolien C.H.M. Maas
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - David van Klaveren
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Matthias A.W. Merkx
- Department of Oral and Maxillofacial Surgery and IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
- Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Hester F. Lingsma
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Valery E.P.P. Lemmens
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Avinash G. Dinmohamed
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
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Vickers A, O'Brien F, Montorsi F, Galvin D, Bratt O, Carlsson S, Catto JW, Krilaviciute A, Philbin M, Albers P. Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit. BMJ 2023; 381:e071082. [PMID: 37197772 DOI: 10.1136/bmj-2022-071082] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Frank O'Brien
- Department of Urology, Cork University Hospital, Ireland
| | | | - David Galvin
- Department of Surgery, University College Dublin, Ireland
| | - Ola Bratt
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Sigrid Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - James Wf Catto
- Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, UK
| | - Agne Krilaviciute
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Peter Albers
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany
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22
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Govers TM, Resnick MJ, Rastinehad AR, Caba L, Groskopf J, van Criekinge W. Cost-effectiveness of an urinary biomarker panel in combination with MRI for prostate cancer diagnosis. World J Urol 2023:10.1007/s00345-023-04389-w. [PMID: 37133554 DOI: 10.1007/s00345-023-04389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/29/2023] [Indexed: 05/04/2023] Open
Abstract
PURPOSE The health impact and cost-effectiveness of the biomarker test SelectMDx were evaluated when used in combination with MRI, in two US populations: biopsy naïve men and men with a previous negative biopsy. METHODS Using a decision model, the current MRI strategy was compared with two SelectMDx strategies: SelectMDx used before MRI to select men for MRI and SelectMDx used after a negative MRI to select men for biopsy. Parameters were informed by the literature most relevant for both populations. Differences in quality-adjusted life years (QALYs) and costs between the current strategy and the SelectMDx strategies were calculated using two different assumptions regarding PCa-specific mortality (SPCG-4 and PIVOT). RESULTS In biopsy naïve men, the use of SelectMDx before MRI results in a gain of 0.004 QALY per patient under the SPCG-4 scenario, and a gain of 0.030 QALY under the PIVOT scenario. The cost savings are $1650 per patient. When used after MRI, SelectMDx results in a QALY gain per patient of 0.004 (SPCG-4), and 0.006 (PIVOT) with $262 in cost savings. In the previous negative population, SelectMDx before MRI results in a QALY gain of 0.006 (SPCG-4) and 0.022 (PIVOT), with $1281 in cost savings per patient. SelectMDx after MRI results in a QALY gain of 0.003 (SPCG-4) and 0.004 (PIVOT) with $193 in cost savings. CONCLUSION Application of SelectMDx results in better health outcomes and cost savings. The value of SelectMDx was highest when used before MRI to select patients for MRI and subsequent biopsy.
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Affiliation(s)
- Tim M Govers
- Department of Medical Imaging, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 10, 6500 HB, Nijmegen, The Netherlands.
| | - Matthew J Resnick
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
- Embold Health, Nashville, TN, USA
| | | | | | - Jack Groskopf
- Department of Bioinformatics, Ghent University, Ghent, Belgium
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23
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Remmers S, Nieboer D, Roobol MJ. The Patient Journey from Randomization to Detection of Prostate Cancer and Death: Results from ERSPC Rotterdam. EUR UROL SUPPL 2023; 51:1-6. [PMID: 37187725 PMCID: PMC10175721 DOI: 10.1016/j.euros.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 05/17/2023] Open
Abstract
Background The ERSPC study has demonstrated that prostate-specific antigen (PSA)-based screening results in a relative increase in diagnosis of (low-risk) prostate cancer (PCa) and a reduction in metastatic disease and PCa mortality. Objective To evaluate the burden of PCa among men randomized to active screening compared to those in the control arm in ERSPC Rotterdam. Design setting and participants We analyzed data for participants in the Dutch section of the ERSPC, including 21 169 men randomized to the screening arm and 21 136 randomized to the control arm. Men in the screening arm were invited for PSA-based screening every 4 yr, and transrectal ultrasound-guided prostate biopsy was recommended for those with PSA ≥3.0 ng/ml. Outcome measurements and statistical analysis We analyzed detailed follow-up and mortality data up to January 1, 2019, to a maximum of 21 yr, using multistate models. Results and limitations At 21 yr, 3046 men (14%) had been diagnosed with nonmetastatic PCa and 161 (0.76%) with metastatic PCa in the screening arm. In the control arm, 1698 men (8.0%) had been diagnosed with nonmetastatic PCa and 346 (1.6%) with metastatic PCa. In comparison to the control arm, men in the screening arm were diagnosed with PCa almost 1 yr earlier and if diagnosed with nonmetastatic PCa lived on average for almost 1 yr longer without disease progression. Among those who experienced biochemical recurrence (18-19% after nonmetastatic PCa), progression to metastatic disease or death was quicker in the control arm: men in the screening arm lived for 7.17 yr without progression, while the progression-free interval was only 1.59 yr for men in the control arm over a 10-yr time period. Among those who experienced metastatic disease, men in both study arms lived for 5 yr over a 10-yr time period. Conclusions PCa diagnosis was earlier after study entry for men in the PSA-based screening arm. However, disease progression was not as fast in the screening arm as in the control arm: once men in the control arm experienced biochemical recurrence, progression to metastatic disease or death was 5.6 yr faster than in the screening arm. Our results confirm the ability of early disease detection to reduce suffering and death from PCa at the cost of earlier (and more frequent) treatment-induced reductions in quality of life. Patient summary Our study shows that early detection of prostate cancer can reduce suffering and death from this disease. However, screening based on measurement of prostate-specific antigen (PSA) can also result in an earlier treatment-induced reduction in quality of life.
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Affiliation(s)
- Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
- Corresponding author. Department of Urology, Erasmus University Medical Center, P.O. Box 2040, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Tel. +31 10 7032 239; Fax: +31 10 7035 315.
| | - Daan Nieboer
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Monique J. Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
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24
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Carlsson SV. Introduction to a seminar on revisiting the value of PSA-based prostate cancer screening. Urol Oncol 2023; 41:76-77. [PMID: 35523706 DOI: 10.1016/j.urolonc.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Sigrid V Carlsson
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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25
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Prostate cancer screening: Continued controversies and novel biomarker advancements. Curr Urol 2022; 16:197-206. [PMID: 36714234 PMCID: PMC9875204 DOI: 10.1097/cu9.0000000000000145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023] Open
Abstract
Prostate cancer (PCa) screening remains one of the most controversial topics in clinical and public health. Despite being the second most common cancer in men worldwide, recommendations for screening using prostate-specific antigen (PSA) are unclear. Early detection and the resulting postscreening treatment lead to overdiagnosis and overtreatment of otherwise indolent cases. In addition, several unwanted harms are associated with PCa screening process. This literature review focuses on the limitations of PSA-specific PCa screening, reasons behind the screening controversy, and the novel biomarkers and advanced innovative methodologies that improve the limitations of traditional screening using PSA. With the verdict of whether or not to screen not yet unanimous, we hope to aid in resolution of the long-standing debate.
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26
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Mo LC, Zhang XJ, Zheng HH, Huang XP, Zheng L, Zhou ZR, Wang JJ. Development of a novel nomogram for predicting clinically significant prostate cancer with the prostate health index and multiparametric MRI. Front Oncol 2022; 12:1068893. [PMID: 36523980 PMCID: PMC9745809 DOI: 10.3389/fonc.2022.1068893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION On prostate biopsy, multiparametric magnetic resonance imaging (mpMRI) and the Prostate Health Index (PHI) have allowed prediction of clinically significant prostate cancer (csPCa). METHODS To predict the likelihood of csPCa, we created a nomogram based on a multivariate model that included PHI and mpMRI. We assessed 315 males who were scheduled for prostate biopsies. RESULTS We used the Prostate Imaging Reporting and Data System version 2 (PI-RADS V2) to assess mpMRI and optimize PHI testing prior to biopsy. Univariate analysis showed that csPCa may be identified by PHI with a cut-off value of 77.77, PHID with 2.36, and PI-RADS with 3 as the best threshold. Multivariable logistic models for predicting csPCa were developed using PI-RADS, free PSA (fPSA), PHI, and prostate volume. A multivariate model that included PI-RADS, fPSA, PHI, and prostate volume had the best accuracy (AUC: 0.882). Decision curve analysis (DCA), which was carried out to verify the nomogram's clinical applicability, showed an ideal advantage (13.35% higher than the model that include PI-RADS only). DISCUSSION In conclusion, the nomogram based on PHI and mpMRI is a valuable tool for predicting csPCa while avoiding unnecessary biopsy as much as possible.
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Affiliation(s)
- Li-Cai Mo
- Department of Urology, Taizhou Hospital of Zhejiang Province affiliated with Wenzhou Medical University, Linhai, Taizhou, Zhejiang, China
| | - Xian-Jun Zhang
- Department of Urology, Taizhou Hospital of Zhejiang Province affiliated with Wenzhou Medical University, Linhai, Taizhou, Zhejiang, China
| | - Hai-Hong Zheng
- Department of Pathology, Taizhou Hospital of Zhejiang Province affiliated with Wenzhou Medical University, Linhai, Taizhou, Zhejiang, China
| | - Xiao-peng Huang
- Department of Urology, Taizhou Cancer Hospital, Wenling, Taizhou, Zhejiang, China
| | - Lin Zheng
- Department of Radiation Oncology Center, Taizhou Cancer Hospital, Wenling, Taizhou, Zhejiang, China
| | - Zhi-Rui Zhou
- Department of Radiation Oncology Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jia-Jia Wang
- Department of Traditional Chinese Medicine, Taizhou Hospital of Zhejiang Province affiliated with Wenzhou Medical University, Linhai, Taizhou, Zhejiang, China
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Hao S, Discacciati A, Eklund M, Heintz E, Östensson E, Elfström KM, Clements MS, Nordström T. Cost-effectiveness of Prostate Cancer Screening Using Magnetic Resonance Imaging or Standard Biopsy Based on the STHLM3-MRI Study. JAMA Oncol 2022; 9:2798261. [PMID: 36355382 PMCID: PMC9650623 DOI: 10.1001/jamaoncol.2022.5252] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/23/2022] [Indexed: 11/12/2022]
Abstract
Importance The combination of prostate-specific antigen (PSA) testing with magnetic resonance imaging (MRI) for prostate cancer detection has rarely been evaluated in a screening context. The STHLM3-MRI screening-by-invitation study (NCT03377881) has reported the benefits of using MRI with subsequent combined targeted and standard biopsies compared with using standard biopsies alone. Objective To investigate the cost-effectiveness of prostate cancer screening using MRI with combined targeted and standard biopsies compared with standard biopsies alone among men aged 55 to 69 years in Sweden, based on evidence from the STHLM3-MRI study. Design, Setting, and Participants This economic evaluation study was conducted from a lifetime health care perspective using a microsimulation model to evaluate no screening and screening strategies among adult men in Sweden. Men aged 55 to 69 years in Sweden were simulated for no screening and screening strategies. Input parameters were obtained from the STHLM3-MRI study and recent reviews. One-way and probabilistic sensitivity analyses were performed in May 2022. Interventions No screening, quadrennial PSA screening using standard biopsies alone, and MRI-based screening using combined targeted and standard biopsies. Main Outcomes and Measures The number of tests, incidence, deaths, costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICERs) were estimated. Results A total 603 men were randomized to the standard arm, 165 of these participants (27.4%) did not undergo standard biopsy; 929 men were randomized to the experimental arm, 111 (11.9%) of whom did undergo MRI or any biopsy. Compared with no screening, the screening strategies were associated with reduced lifetime prostate cancer-related deaths by 6% to 9%. Screening with MRI and the combined biopsies resulted in an ICER of US $53 736, which is classified as a moderate cost per QALY gained in Sweden. Relative to screening with standard biopsies alone, MRI-based screening reduced the number of both lifetime biopsies and overdiagnosis by approximately 50% and had a high probability of being cost-effective than the traditional PSA screening. Conclusions and Relevance For prostate cancer screening, this economic evaluation study found that PSA testing followed by MRI with subsequent combined targeted and standard biopsies had a high probability to be more cost-effective compared with the traditional screening pathway using PSA and standard biopsy. MRI-based screening may be considered for early detection of prostate cancer in Sweden.
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Affiliation(s)
- Shuang Hao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Discacciati
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emelie Heintz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Ellinor Östensson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - K Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mark S Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Danderyd, Sweden
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Barbier MC, Tomonaga Y, Menges D, Yebyo HG, Haile SR, Puhan MA, Schwenkglenks M. Survival modelling and cost-effectiveness analysis of treatments for newly diagnosed metastatic hormone-sensitive prostate cancer. PLoS One 2022; 17:e0277282. [PMID: 36327294 PMCID: PMC9632884 DOI: 10.1371/journal.pone.0277282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In metastatic hormone-sensitive prostate cancer (mHSPC) treatment, survival benefits have been shown by adding docetaxel or recent androgen receptor axis-targeted therapies (ARATs) abiraterone, apalutamide, or enzalutamide to androgen deprivation therapy (ADT). However, the optimal treatment strategy in terms of costs and effects is unclear, not least due to high ARAT costs. METHODS To assess treatment cost-effectiveness, we developed a Markov cohort model with health states of progression-free disease, progressive disease and death for men with newly diagnosed mHSPC, with a 30-year time horizon. Survival data, adverse events and utilities were informed by randomized controlled trial results, our meta-analysis of re-created individual patient survival data, and publicly available sources of unit costs. We applied a Swiss healthcare payer perspective and discounted costs and effects by 3%. RESULTS We found a significant overall survival benefit for ADT+abiraterone versus ADT+docetaxel. The corresponding incremental cost-effectiveness ratio (ICER) was predicted to be EUR 39,814 per quality-adjusted life-year (QALY) gained. ADT+apalutamide and ADT+enzalutamide incurred higher costs and lower QALYs compared to ADT+abiraterone. For all ARATs, drug costs constituted the most substantial cost component. Results were stable except for a large univariable reduction in the pre-progression utility under ADT+abiraterone and very large variations in drug prices. CONCLUSIONS Our model projected ADT+abiraterone to be cost-effective compared to ADT+docetaxel at a willingness-to-pay threshold of EUR 70,400/QALY (CHF 100,000 applying purchasing power parities). Given lower estimated QALYs for ADT+apalutamide and ADT+enzalutamide compared to ADT+abiraterone, the former only became cost-effective (the preferred) treatment option(s) at substantial 75-80% (80-90%) price reductions.
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Affiliation(s)
- Michaela C. Barbier
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
- * E-mail:
| | - Yuki Tomonaga
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Henock G. Yebyo
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Sarah R. Haile
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Matthias Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
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French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Diagnosis and management of localised disease. Prog Urol 2022; 32:1275-1372. [DOI: 10.1016/j.purol.2022.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
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Pathirana TI, Pickles K, Riikonen JM, Tikkinen KAO, Bell KJL, Glasziou P. Including Information on Overdiagnosis in Shared Decision Making: A Review of Prostate Cancer Screening Decision Aids. MDM Policy Pract 2022; 7:23814683221129875. [PMID: 36247841 PMCID: PMC9558890 DOI: 10.1177/23814683221129875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 09/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background. Overdiagnosis is an accepted harm of cancer screening, but studies of prostate cancer screening decision aids have not examined provision of information important in communicating the risk of overdiagnosis, including overdiagnosis frequency, competing mortality risk, and the high prevalence of indolent cancers in the population. Methods. We undertook a comprehensive review of all publicly available decision aids for prostate cancer screening, published in (or translated to) the English language, without date restrictions. We included all decision aids from a recent systematic review and screened excluded studies to identify further relevant decision aids. We used a Google search to identify further decision aids not published in peer reviewed medical literature. Two reviewers independently screened the decision aids and extracted information on communication of overdiagnosis. Disagreements were resolved through discussion or by consulting a third author. Results. Forty-one decision aids were included out of the 80 records identified through the search. Most decision aids (n = 32, 79%) did not use the term overdiagnosis but included a description of it (n = 38, 92%). Few (n = 7, 17%) reported the frequency of overdiagnosis. Little more than half presented the benefits of prostate cancer screening before the harms (n = 22, 54%) and only 16, (39%) presented information on competing risks of mortality. Only 2 (n = 2, 5%) reported the prevalence of undiagnosed prostate cancer in the general population. Conclusion. Most patient decision aids for prostate cancer screening lacked important information on overdiagnosis. Specific guidance is needed on how to communicate the risks of overdiagnosis in decision aids, including appropriate content, terminology and graphical display. Highlights Most patient decision aids for prostate cancer screening lacks important information on overdiagnosis.Specific guidance is needed on how to communicate the risks of overdiagnosis.
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Affiliation(s)
- Thanya I. Pathirana
- Thanya I. Pathirana, School of Medicine and
Dentistry, Griffith University, Sunshine Coast Health Institute, Sunshine Coast
University Hospital, 3 Doherty St, Birtinya QLD 4575, Australia;
()
| | - Kristen Pickles
- Sydney School of Public Health, Faculty of
Medicine and Health, University of Sydney, Camperdown NSW, Australia
| | - Jarno M. Riikonen
- Department of Urology, Tampere University
Hospital, Tampere, Finland,Faculty of Medicine and Life Science,
University of Tampere, Tampere, Finland
| | - Kari A. O. Tikkinen
- Department of Urology, University of Helsinki
and Helsinki University Hospital, Helsinki, Finland,Department of Surgery, South Karelia Central
Hospital, Lappeenranta, Finland
| | - Katy J. L. Bell
- Sydney School of Public Health, Faculty of
Medicine and Health, University of Sydney, Camperdown NSW, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare,
Faculty of Health Sciences and Medicine, Bond University, Gold Coast,
Australia
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31
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Van Poppel H, Albreht T, Basu P, Hogenhout R, Collen S, Roobol M. Serum PSA-based early detection of prostate cancer in Europe and globally: past, present and future. Nat Rev Urol 2022; 19:562-572. [PMID: 35974245 DOI: 10.1038/s41585-022-00638-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Abstract
In the pre-PSA-detection era, a large proportion of men were diagnosed with metastatic prostate cancer and died of the disease; after the introduction of the serum PSA test, randomized controlled prostate cancer screening trials in the USA and Europe were conducted to assess the effect of PSA screening on prostate cancer mortality. Contradictory outcomes of the trials and the accompanying overdiagnosis resulted in recommendations against prostate cancer screening by organizations such as the United States Preventive Services Task Force. These recommendations were followed by a decline in PSA testing and a rise in late-stage diagnosis and prostate cancer mortality. Re-evaluation of the randomized trials, which accounted for contamination, showed that PSA-based screening does indeed reduce prostate cancer mortality; however, the debate about whether to screen or not to screen continues because of the considerable overdiagnosis that occurs using PSA-based screening. Meanwhile, awareness among the population of prostate cancer as a potentially lethal disease stimulates opportunistic screening practices that further increase overdiagnosis without the benefit of mortality reduction. However, in the past decade, new screening tools have been developed that make the classic PSA-only-based screening an outdated strategy. With improved use of PSA, in combination with age, prostate volume and with the application of prostate cancer risk calculators, a risk-adapted strategy enables improved stratification of men with prostate cancer and avoidance of unnecessary diagnostic procedures. This combination used with advanced detection techniques (such as MRI and targeted biopsy), can reduce overdiagnosis. Moreover, new biomarkers are becoming available and will enable further improvements in risk stratification.
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Affiliation(s)
| | - Tit Albreht
- National Institute of Public Health, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Partha Basu
- International Agency for Research on Cancer, Lyon, France
| | - Renée Hogenhout
- Erasmus University Medical Center, Cancer Institute, Rotterdam, Netherlands
| | - Sarah Collen
- European Association of Urology, Arnhem, Netherlands
| | - Monique Roobol
- Erasmus University Medical Center, Cancer Institute, Rotterdam, Netherlands
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32
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van der Sar ECA, Keusters WR, van Kalmthout LWM, Braat AJAT, de Keizer B, Frederix GWJ, Kooistra A, Lavalaye J, Lam MGEH, van Melick HHE. Cost-effectiveness of the implementation of [ 68Ga]Ga-PSMA-11 PET/CT at initial prostate cancer staging. Insights Imaging 2022; 13:132. [PMID: 35962838 PMCID: PMC9375809 DOI: 10.1186/s13244-022-01265-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background Despite its high specificity, PSMA PET/CT has a moderate to low sensitivity of 40–50% for pelvic lymph node detection, implicating that a negative PSMA PET/CT cannot rule out lymph node metastases. This study investigates a strategy of implementing PSMA PET/CT for initial prostate cancer staging and treatment planning compared to conventional diagnostics. In this PSMA PET/CT strategy, a bilateral extended pelvic lymph node dissection (ePLND) is only performed in case of a negative PSMA PET/CT; in case of a positive scan treatment planning is solely based on PSMA PET/CT results. Method A decision table and lifetime state transition model were created. Quality-adjusted life years and health care costs were modelled over lifetime. Results The PSMA PET/CT strategy of treatment planning based on initial staging with [68Ga]Ga-PSMA-11 PET/CT results in cost-savings of €674 and a small loss in quality of life (QoL), 0.011 QALY per patient. The positive effect of [68Ga]Ga-PSMA-11 PET/CT was caused by abandoning both an ePLND and unnecessary treatment in iM1 patients, saving costs and resulting in higher QoL. The negative effect was caused by lower QoL and high costs in the false palliative state, due to pN1lim patients (≤ 4 pelvic lymph node metastases) being falsely diagnosed as iN1ext (> 4 pelvic lymph node metastases). These patients received subsequently palliative treatment instead of potentially curative therapy. Conclusion Initial staging and treatment planning based on [68Ga]Ga-PSMA-11 PET/CT saves cost but results in small QALY loss due to the rate of false positive findings. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01265-w.
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Affiliation(s)
- Esmée C A van der Sar
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Willem R Keusters
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Geert W J Frederix
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anko Kooistra
- Department of Urology, Meander Medical Center, Amersfoort, The Netherlands
| | - Jules Lavalaye
- Department of Nuclear Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Heijnsdijk EA, Verkleij ML, Carlton J, Horwood AM, Fronius M, Kik J, Sloot F, Vladutiu C, Simonsz HJ, de Koning HJ. The cost-effectiveness of different visual acuity screening strategies in three European countries: A microsimulation study. Prev Med Rep 2022; 28:101868. [PMID: 35801001 PMCID: PMC9253646 DOI: 10.1016/j.pmedr.2022.101868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022] Open
Abstract
Childhood vision screening programmes in Europe differ by age, frequency and location at which the child is screened, and by the professional who performs the test. The aim of this study is to compare the cost-effectiveness for three countries with different health care structures. We developed a microsimulation model of amblyopia. The natural history parameters were calibrated to a Dutch observational study. Sensitivity, specificity, attendance, lost to follow-up and costs in the three countries were based on the EUSCREEN Survey. Quality adjusted life-years (QALYs) were calculated using assumed utility loss for unilateral persistent amblyopia (1%) and bilateral visual impairment (8%). We calculated the cost-effectiveness of screening (with 3.5% annual discount) by visual acuity measurement at age 5 years or 4 and 5 years in the Netherlands by nurses in child healthcare centres, in England and Wales by orthoptists in schools and in Romania by urban kindergarten nurses. We compared screening at various ages and with various frequencies. Assuming an amblyopia prevalence of 36 per 1,000 children, the model predicted that 7.2 cases of persistent amblyopia were prevented in the Netherlands, 6.6 in England and Wales and 4.5 in Romania. The cost-effectiveness was €24,159, €19,981 and €23,589, per QALY gained respectively, compared with no screening. Costs/QALY was influenced most by assumed utility loss of unilateral persistent amblyopia. For all three countries, screening at age 5, or age 4 and 5 years were optimal. Despite differences in health care structure, vision screening by visual acuity measurement seemed cost-effective in all three countries.
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Affiliation(s)
- Eveline A.M. Heijnsdijk
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Corresponding author at: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
| | - Mirjam L. Verkleij
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Anna M. Horwood
- Infant Vision Laboratory, School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Maria Fronius
- Goethe University, Department of Ophthalmology, Child Vision Research Unit, Frankfurt am Main, Germany
| | - Jan Kik
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frea Sloot
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Huibert J. Simonsz
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Harry J. de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Abstract
PURPOSE Our goal was to analyze results from 22 years of followup in the Göteborg randomized prostate cancer (PC) screening trial. MATERIALS AND METHODS In December 1994, 20,000 men born 1930-1944 were randomly extracted from the Swedish population register and were randomized (1:1) into either a screening group (SG) or to a control group (CG). Men in the SG were repeatedly invited for biennial prostate specific antigen testing up to an average age of 69 years. Main endpoints were PC incidence and mortality (intention-to-screen principle). RESULTS After 22 years, 1,528 men in the SG and 1,124 men in the CG had been diagnosed with PC. In total, 112 PC deaths occurred in the SG and 158 in the CG. Compared with the CG, the SG showed a PC incidence rate ratio (RR) of 1.42 (95% CI, 1.31-1.53) and a PC mortality RR of 0.71 (95% CI, 0.55-0.91). The 22-year cumulative PC mortality rate was 1.55% (95% CI, 1.29-1.86) in the SG and 2.13% (95% CI, 1.83-2.49) in the CG. Correction for nonattendance (Cuzick method) yielded a RR of PC mortality of 0.59 (95% CI, 0.43-0.80). Number needed to invite and number needed to diagnose was estimated to 221 and 9, respectively. PC death risk was increased in the following groups: nontesting men, men entering the program after age 60 and men with >10 years of followup after screening termination. CONCLUSIONS Prostate specific antigen-based screening substantially decreases PC mortality. However, not attending, starting after age 60 and stopping at age 70 seem to be major pitfalls regarding PC death risk.
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Kshirsagar PG, Seshacharyulu P, Muniyan S, Rachagani S, Smith LM, Thompson C, Shah A, Mallya K, Kumar S, Jain M, Batra SK. DNA-gold nanoprobe-based integrated biosensing technology for non-invasive liquid biopsy of serum miRNA: A new frontier in prostate cancer diagnosis. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2022; 43:102566. [PMID: 35569810 PMCID: PMC9942096 DOI: 10.1016/j.nano.2022.102566] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/22/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
The low specificity of prostate-specific antigen contributes to overdiagnosis and ov ertreatment of prostate cancer (PCa) patients. Hence, there is an urgent need for inclusive diagnostic platforms that could improve the diagnostic accuracy of PCa. Dysregulated miRNAs are closely associated with the progression and recurrence and have emerged as promising diagnostic and prognostic biomarkers for PCa. Nevertheless, simple, rapid, and ultrasensitive quantification of serum miRNAs is highly challenging. This study designed, synthesized, and demonstrated the practicability of DNA-linked gold nanoprobes (DNA-AuNPs) for the single-step quantification of miR-21/miR-141/miR-375. In preclinical study, the assay differented PCa Pten conditional knockout (PtencKO) mice compared to their age-matched Pten wild-type (PtenWT) control mice. In human sera, receiver operating characteristic (ROC) curve-based correlation analyses revealed clear discrimination between PCa patients from normal healthy controls using training and validation sets. Overall, we established integrated nano-biosensing technology for the PCR-free, non-invasive liquid biopsies of multiple miRNAs for PCa diagnosis.
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Affiliation(s)
- Prakash G. Kshirsagar
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Parthasarathy Seshacharyulu
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sakthivel Muniyan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Satyanarayan Rachagani
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lynette M. Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Christopher Thompson
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ashu Shah
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kavita Mallya
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sushil Kumar
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Maneesh Jain
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA; Fred and Pamela Buffett Cancer Center, Omaha, NE, USA.
| | - Surinder K. Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Fred and Pamela Buffett Cancer Center, Omaha, Nebraska, USA.,Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Corresponding authors: Surinder K. Batra, Ph.D., , Phone: 402-559-5455; Maneesh Jain, Ph.D., , Phone: 402-559-7667
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Diagnostic Accuracy of Predictive Models in Prostate Cancer: A Systematic Review and Meta-Analysis. Prostate Cancer 2022; 2022:1742789. [PMID: 35719243 PMCID: PMC9200600 DOI: 10.1155/2022/1742789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022] Open
Abstract
Aim Accurate diagnosis of prostate cancer (PCa) has a fundamental role in clinical and patient care. Recent advances in diagnostic testing and marker lead to standardized interpretation and increased prescription by clinicians to improve the detection of clinically significant PCa and select patients who strictly require targeted biopsies. Methods In this study, we present a systematic review of the overall diagnostic accuracy of each testing panel regarding the panel details. In this meta-analysis, using a structured search, Web of Science and PubMed databases were searched up to 23 September 2019 with no restrictions and filters. The study's outcome was the AUC and 95% confidence interval of prediction models. This index was reported as an overall and based on the WHO region and models with/without MRI. Results The thirteen final articles included 25,691 people. The overall AUC and 95% CI in thirteen studies were 0.78 and 95% CI: 0.73–0.82. The weighted average AUC in the countries of the Americas region was 0.73 (95% CI: 0.70–0.75), and in European countries, it was 0.80 (95% CI: 0.72–0.88). In four studies with MRI, the average weighted AUC was 0.88 (95% CI: 0.86–0.90), while in other articles where MRI was not a parameter in the diagnostic model, the mean AUC was 0.73 (95% CI: 0.70–0.76). Conclusions The present study's findings showed that MRI significantly improved the detection accuracy of prostate cancer and had the highest discrimination to distinguish candidates for biopsy.
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Vickers AJ, Sud A, Bernstein J, Houlston R. Polygenic risk scores to stratify cancer screening should predict mortality not incidence. NPJ Precis Oncol 2022; 6:32. [PMID: 35637246 PMCID: PMC9151796 DOI: 10.1038/s41698-022-00280-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
Population-based cancer screening programs such as mammography or colonscopy generally directed at all healthy individuals in a given age stratum. It has recently been proposed that cancer screening could be restricted to a high-risk subgroup based on polygenic risk scores (PRSs) using panels of single-nucleotide polymorphisms (SNPs). These PRSs were, however, generated to predict cancer incidence rather than cancer mortality and will not necessarily address overdiagnosis, a major problem associated with cancer screening programs. We develop a simple net-benefit framework for evaluating screening approaches that incorporates overdiagnosis. We use this methodology to demonstrate that if a PRS does not differentially discriminate between incident and lethal cancer, restricting screening to a subgroup with high scores will only improve screening outcomes in a small number of scenarios. In contrast, restricting screening to a subgroup defined as high-risk based on a marker that is more strongly predictive of mortality than incidence will often afford greater net benefit than screening all eligible individuals. If PRS-based cancer screening is to be effective, research needs to focus on identifying PRSs associated with cancer mortality, an unchartered and clinically-relevant area of research, with a much higher potential to improve screening outcomes.
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Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Amit Sud
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Jonine Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
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Guan Y, Wang X, Guan K, Wang D, Bi X, Xiao Z, Xiao Z, Shan X, Hu L, Ma J, Li C, Zhang Y, Shou J, Wang B, Qian Z, Xing N. Copy number variation of urine exfoliated cells by low-coverage whole genome sequencing for diagnosis of prostate adenocarcinoma: a prospective cohort study. BMC Med Genomics 2022; 15:104. [PMID: 35513884 PMCID: PMC9069213 DOI: 10.1186/s12920-022-01253-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 12/31/2022] Open
Abstract
Background Non-invasive, especially the urine-based diagnosis of prostate cancer (PCa) remains challenging. Although prostate cancer antigen (PSA) is widely used in prostate cancer screening, the false positives may result in unnecessary invasive procedures. PSA elevated patients are triaged to further evaluation of free/total PSA ratio (f/t PSA), to find out potential clinically significant PCa before undergoing invasive procedures. Genomic instability, especially chromosomal copy number variations (CNVs) were proved much more tumor specific. Here we performed a prospective study to evaluate the diagnostic value of CNV via urine-exfoliated cell DNA analysis in PCa. Methods We enrolled 28 PSA elevated patients (≥ 4 ng/ml), including 16 PCa, 9 benign prostate hypertrophy (BPH) and 3 prostatic intraepithelial neoplasia (PIN). Fresh initial portion urine was collected after hospital admission. Urine exfoliated cell DNA was analyzed by low coverage Whole Genome Sequencing, followed by CNV genotyping by the prostate cancer chromosomal aneuploidy detector (ProCAD). CNVs were quantified in absolute z-score (|Z|). Serum free/total PSA ratio (f/t PSA) was reported altogether. Results In patients with PCa, the most frequent CNV events were chr3q gain (n = 2), chr8q gain (n = 2), chr2q loss (n = 4), and chr18q loss (n = 3). CNVs were found in 81.2% (95% Confidence Interval (CI) 53.7–95.0%) PCa. No CNV was identified in BPH patients. A diagnosis model was established by incorporating all CNVs. At the optimal cutoff of |Z|≥ 2.50, the model reached an AUC of 0.91 (95% CI 0.83–0.99), a sensitivity of 81.2% and a specificity of 100%. The CNV approach significantly outperformed f/t PSA (AUC = 0.62, P = 0.012). Further analyses showed that the CNV positive rate was significantly correlated with tumor grade. CNVs were found in 90.9% (95% CI 57.1–99.5%) high grade tumors and 60.0% (95% CI 17.0–92.7%) low grade tumors. No statistical significance was found for patient age, BMI, disease history and family history. Conclusions Urine exfoliated cells harbor enriched CNV features in PCa patients. Urine detection of CNV might be a biomarker for PCa diagnosis, especially in terms of the clinically significant high-grade tumors. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01253-5.
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Affiliation(s)
- Youyan Guan
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiaobing Wang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Kaopeng Guan
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dong Wang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xingang Bi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhendong Xiao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zejun Xiao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xingli Shan
- Cancer Hospital of Huanxing, ChaoYang District, Beijing, 100122, China
| | - Linjun Hu
- Cancer Hospital of Huanxing, ChaoYang District, Beijing, 100122, China
| | - Jianhui Ma
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Changling Li
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yong Zhang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | | | | | - Nianzeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Heijnsdijk EAM, Gulati R, Lange JM, Tsodikov A, Roberts R, Etzioni R. Evaluation of Prostate Cancer Screening Strategies in a Low-Resource, High-risk Population in the Bahamas. JAMA HEALTH FORUM 2022; 3:e221116. [PMID: 35977253 PMCID: PMC9123504 DOI: 10.1001/jamahealthforum.2022.1116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/29/2022] [Indexed: 12/29/2022] Open
Abstract
Importance The benefit of prostate-specific antigen screening may be greatest in high-risk populations, including men of African descent in the Caribbean. However, organized screening may not be sustainable in low- and middle-income countries. Objective To evaluate the expected population outcomes and resource use of conservative prostate-specific antigen screening programs in the Bahamas. Design Setting and Participants Prostate cancer incidence from GLOBOCAN and prostate-specific antigen screening data for 4300 men from the Bahamas were used to recalibrate 2 decision analytical models previously used to study prostate-specific antigen screening for Black men in the United States. Data on age and results obtained from prostate-specific antigen screening tests performed in Nassau from 2004 to 2018 and in Freeport from 2013 to 2018 were used. Data were analyzed from January 15, 2021, to March 23, 2022. Interventions One or 2 screenings for men aged 45 to 60 years and conservative criteria for biopsy (prostate-specific antigen level >10 ng/mL) and curative treatment (Gleason score ≥8) were modeled. Categories of Gleason scores were 6 or lower, 7, and 8 or higher, with higher scores indicating higher risk of cancer progression and death. Main Outcomes and Measures Projected numbers of tests and biopsies, prostate cancer (over)diagnoses, lives saved, and life-years gained owing to screening from 2022 to 2040. Results In this decision analytical modeling study, screening histories from 4300 men (median age, 54 years; range, 13-101 years) tested between 2004 and 2018 at 2 sites in the Bahamas were used to inform the models. Screening once at 60 years of age was projected to involve 40 000 to 42 000 tests (range between models) and prevent 500 to 600 of 10 000 to 14 000 prostate cancer deaths. Screening at 50 and 60 years doubled the number of tests but increased lives saved by only 15% to 16%. Among onetime strategies, screening once at 60 years of age involved the fewest tests per life saved (74-84 tests) and curative treatments per life saved (1.2-2.8 treatments). Conclusions and Relevance The findings of this decision analytical modeling study of prostate cancer screening in the Bahamas suggest that limited screening offered modest benefits that varied with screening ages and number of tests. The results can be combined with data on capacity constraints and evaluated relative to competing national public health priorities.
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Affiliation(s)
- Eveline A. M. Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jane M. Lange
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland
| | - Alex Tsodikov
- School of Public Health, University of Michigan, Ann Arbor
| | - Robin Roberts
- University of The West Indies School of Clinical Medicine and Research, Nassau, The Bahamas
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland
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Lin Y, Liu G, Liu C, Xie H, Wang X, Huang Y, Jin L, Chen H. Urothelial carcinoembryonic antigen 1 score for early detection of prostate cancer and risk prediction. Cancer Med 2022; 11:2875-2885. [PMID: 35289508 PMCID: PMC9359874 DOI: 10.1002/cam4.4629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/24/2022] [Accepted: 02/21/2022] [Indexed: 11/09/2022] Open
Abstract
UCA1 score appears useful in detecting nonhigh-risk (including very low-, low-, or intermediate-risk) prostate cancer. Combination of the PSA level and the UCA1 score may significantly reduce the burden of prostate biopsy.
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Affiliation(s)
- Youdong Lin
- Department of Clinical Laboratory Medicine, Fujian Provincial Hospital, Fujian Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Guihua Liu
- Department of Children Health Care, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chun Liu
- Department of urinary surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Hui Xie
- Department of urinary surgery, Fuzhou NO. 1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaoxian Wang
- Department of Clinical Laboratory Medicine, Fuzhou NO. 1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Yudian Huang
- Department of Pathology, Fuzhou NO. 1 Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China
| | - Long Jin
- Department of Pathology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Huidan Chen
- Department of Clinical Laboratory Medicine, Fujian Provincial Hospital, Fujian Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
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Alijaj N, Pavlovic B, Martel P, Rakauskas A, Cesson V, Saba K, Hermanns T, Oechslin P, Veit M, Provenzano M, Rüschoff JH, Brada MD, Rupp NJ, Poyet C, Derré L, Valerio M, Banzola I, Eberli D. Identification of Urine Biomarkers to Improve Eligibility for Prostate Biopsy and Detect High-Grade Prostate Cancer. Cancers (Basel) 2022; 14:cancers14051135. [PMID: 35267445 PMCID: PMC8909910 DOI: 10.3390/cancers14051135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary The screening of prostate cancer (PCa), based on the serum prostate specific antigen (PSA), is characterized by a high number of false positives, leading to overdiagnosis of healthy men and overtreatment of indolent PCa. This clinical problem severely affects the quality of life of patients, who would benefit from more specific risk stratification models. By performing a mass spectrometry (MS) screening on urine samples collected prior to prostate biopsy, we identified novel biomarkers and validated them by ELISA. Here, we show that an upfront urine test, based on quantitative biomarkers and patient age, has a higher performance compared to PSA (AUC = 0.6020) and is a feasible method to improve the eligibility criteria for prostate biopsy, to detect healthy men (AUC = 0.8196) and clinically significant PCa, thereby reducing the number of unnecessary prostate biopsies. Abstract PCa screening is based on the measurements of the serum prostate specific antigen (PSA) to select men with higher risks for tumors and, thus, eligible for prostate biopsy. However, PSA testing has a low specificity, leading to unnecessary biopsies in 50–75% of cases. Therefore, more specific screening opportunities are needed to reduce the number of biopsies performed on healthy men and patients with indolent tumors. Urine samples from 45 patients with elevated PSA were collected prior to prostate biopsy, a mass spectrometry (MS) screening was performed to identify novel biomarkers and the best candidates were validated by ELISA. The urine quantification of PEDF, HPX, CD99, CANX, FCER2, HRNR, and KRT13 showed superior performance compared to PSA. Additionally, the combination of two biomarkers and patient age resulted in an AUC of 0.8196 (PSA = 0.6020) and 0.7801 (PSA = 0.5690) in detecting healthy men and high-grade PCa, respectively. In this study, we identified and validated novel urine biomarkers for the screening of PCa, showing that an upfront urine test, based on quantitative biomarkers and patient age, is a feasible method to reduce the number of unnecessary prostate biopsies and detect both healthy men and clinically significant PCa.
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Affiliation(s)
- Nagjie Alijaj
- Department of Urology, University Hospital of Zürich and University of Zürich, 8006 Zürich, Switzerland; (N.A.); (B.P.)
| | - Blaz Pavlovic
- Department of Urology, University Hospital of Zürich and University of Zürich, 8006 Zürich, Switzerland; (N.A.); (B.P.)
| | - Paul Martel
- Department of Urology, Urology Research Unit and Urology Biobank, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (P.M.); (A.R.); (V.C.); (L.D.); (M.V.)
| | - Arnas Rakauskas
- Department of Urology, Urology Research Unit and Urology Biobank, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (P.M.); (A.R.); (V.C.); (L.D.); (M.V.)
| | - Valérie Cesson
- Department of Urology, Urology Research Unit and Urology Biobank, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (P.M.); (A.R.); (V.C.); (L.D.); (M.V.)
| | - Karim Saba
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
| | - Thomas Hermanns
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
| | - Pascal Oechslin
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
| | - Markus Veit
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
| | - Maurizio Provenzano
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
| | - Jan H. Rüschoff
- Department of Pathology and Molecular Pathology, University Hospital of Zürich, 8091 Zürich, Switzerland; (J.H.R.); (M.D.B.); (N.J.R.)
| | - Muriel D. Brada
- Department of Pathology and Molecular Pathology, University Hospital of Zürich, 8091 Zürich, Switzerland; (J.H.R.); (M.D.B.); (N.J.R.)
| | - Niels J. Rupp
- Department of Pathology and Molecular Pathology, University Hospital of Zürich, 8091 Zürich, Switzerland; (J.H.R.); (M.D.B.); (N.J.R.)
- Faculty of Medicine, University of Zürich, 8032 Zürich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
| | - Laurent Derré
- Department of Urology, Urology Research Unit and Urology Biobank, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (P.M.); (A.R.); (V.C.); (L.D.); (M.V.)
| | - Massimo Valerio
- Department of Urology, Urology Research Unit and Urology Biobank, University Hospital of Lausanne, 1011 Lausanne, Switzerland; (P.M.); (A.R.); (V.C.); (L.D.); (M.V.)
| | - Irina Banzola
- Department of Urology, University Hospital of Zürich and University of Zürich, 8006 Zürich, Switzerland; (N.A.); (B.P.)
- Correspondence: ; Tel.: +41762503737
| | - Daniel Eberli
- Department of Urology, University Hospital of Zürich, 8091 Zürich, Switzerland; (K.S.); (T.H.); (P.O.); (M.V.); (M.P.); (C.P.); (D.E.)
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Hao S, Heintz E, Östensson E, Discacciati A, Jäderling F, Grönberg H, Eklund M, Nordström T, Clements MS. Cost-Effectiveness of the Stockholm3 Test and Magnetic Resonance Imaging in Prostate Cancer Screening: A Microsimulation Study. Eur Urol 2022; 82:12-19. [PMID: 35094896 DOI: 10.1016/j.eururo.2021.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/10/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Stockholm3 is a risk model that combines the prostate-specific antigen (PSA) test, other plasma protein biomarkers, single nucleotide polymorphisms, and clinical variables. The STHLM3-MRI study (NCT03377881) found that the Stockholm3 test with magnetic resonance imaging (MRI) and combined targeted and systematic biopsies maintained the sensitivity for clinically significant cancers, and reduced the number of benign biopsies and clinically insignificant cancers. OBJECTIVE To assess the cost-effectiveness of MRI-based screening for prostate cancer using either Stockholm3 as a reflex test or PSA alone. DESIGN, SETTING, AND PARTICIPANTS A cost-utility analysis was performed from a lifetime societal perspective using a microsimulation model for men aged 55-69 yr in Sweden. Test characteristics were estimated from the STHLM3-MRI study. INTERVENTION No screening and three quadrennial screening strategies, including either PSA ≥3 ng/ml or Stockholm3 with reflex test thresholds of PSA ≥1.5 or 2 ng/ml as criteria for referral to MRI, were performed, and those who were MRI positive had combined targeted and systematic biopsies. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Predictions included the number of tests, cancer incidence and mortality, costs, and quality-adjusted life-years. Uncertainties in key parameters were assessed using sensitivity analyses. RESULTS AND LIMITATIONS Compared with no screening, the screening strategies were predicted to reduce prostate cancer deaths by 7-9% across a lifetime. The use of Stockholm3 with PSA ≥2 ng/ml resulted in a 60% reduction in MRI compared with screening using PSA. This Stockholm3 strategy was cost-effective with a probability of 70% at a cost-effectiveness threshold of €47 218 (500 000 Swedish Kronor). As a potential limitation, the economic perspective was specific to Sweden. CONCLUSIONS Screening with the Stockholm3 test at a reflex threshold of PSA ≥2 ng/ml and MRI was predicted to be cost-effective in Sweden. PATIENT SUMMARY The Stockholm3 test with image-based screening may reduce screening-related harms and costs, while maintaining the health benefits from early detection of prostate cancer.
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Affiliation(s)
- Shuang Hao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emelie Heintz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Ellinor Östensson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Discacciati
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Jäderling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden; Department of Radiology, Capio St Göran Hospital, Stockholm, Sweden
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Danderyd, Sweden
| | - Mark S Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Carlsson SV, Murata K, Danila DC, Lilja H. PSA: role in screening and monitoring patients with prostate cancer. Cancer Biomark 2022. [DOI: 10.1016/b978-0-12-824302-2.00001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Keeney E, Thom H, Turner E, Martin RM, Morley J, Sanghera S. Systematic Review of Cost-Effectiveness Models in Prostate Cancer: Exploring New Developments in Testing and Diagnosis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:133-146. [PMID: 35031092 PMCID: PMC8752463 DOI: 10.1016/j.jval.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Recent innovations in prostate cancer diagnosis include new biomarkers and more accurate biopsy methods. This study assesses the evidence base on cost-effectiveness of these developments (eg, Prostate Health Index and magnetic resonance imaging [MRI]-guided biopsy) and identifies areas of improvement for future cost-effectiveness models. METHODS A systematic review using the National Health Service Economic Evaluation Database, MEDLINE, Embase, Health Technology Assessment databases, National Institute for Health and Care Excellence guidelines, and United Kingdom National Screening Committee guidance was performed, between 2009 and 2021. Relevant data were extracted on study type, model inputs, modeling methods and cost-effectiveness conclusions, and results narratively synthesized. RESULTS A total of 22 model-based economic evaluations were included. A total of 11 compared the cost-effectiveness of new biomarkers to prostate-specific antigen testing alone and all found biomarkers to be cost saving. A total of 8 compared MRI-guided biopsy methods to transrectal ultrasound-guided methods and found MRI-guided methods to be most cost-effective. Newer detection methods showed a reduction in unnecessary biopsies and overtreatment. The most cost-effective follow-up strategy in men with a negative initial biopsy was uncertain. Many studies did not model for stage or grade of cancer, cancer progression, or the entire testing and treatment pathway. Few fully accounted for uncertainty. CONCLUSIONS This review brings together the cost-effectiveness literature for novel diagnostic methods in prostate cancer, showing that most studies have found new methods to be more cost-effective than standard of care. Several limitations of the models were identified, however, limiting the reliability of the results. Areas for further development include accurately modeling the impact of early diagnostic tests on long-term outcomes of prostate cancer and fully accounting for uncertainty.
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Affiliation(s)
- Edna Keeney
- Health Economics Bristol, Bristol Medical School, University of Bristol, Bristol, England, UK.
| | - Howard Thom
- Health Economics Bristol, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Emma Turner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Richard M Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK; MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Josie Morley
- Health Economics Bristol, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Sabina Sanghera
- Health Economics Bristol, Bristol Medical School, University of Bristol, Bristol, England, UK
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Ding XF, Luan Y, Xia AL, Zhu LY, Xiao Q, Chen J, Chen HP, Han YX, Liu Z. Application of 16 G Biopsy Needle in Transperineal Template-Guided Prostate Biopsy. Urol Int 2021; 106:909-913. [PMID: 34915528 DOI: 10.1159/000520373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the clinical value of 16 G biopsy needle in transperineal template-guided prostate biopsy (TTPB), compared with 18 G biopsy needle. METHODS The patients who underwent TTPB from August 2020 to February 2021 were randomized into 2 groups using a random number table. The control group (n = 65) and the observation group (n = 58) performed biopsy with 18 G (Bard MC l820) and 16 G (Bard MC l616) biopsy needles, respectively. Positive rate of biopsy, Gleason score, complications, and pain score were statistically analyzed. RESULTS The age, prostate volume, PSA, and the number of cores were comparable between the 2 groups. The positive rate of biopsy in the observation group was 68.9% (40/58), meanwhile the control group was 46.2% (30/65). There was statistical difference between the 2 groups (p = 0.011). Gleason score of the observation group (8 [7-9]) was higher than that of the control group (8 [6-9]) (p = 0.038). There was no significant difference in pain score and complications including hematuria, hematospermia, perineal hematoma, infection, and urinary retention between the 2 groups (p > 0.05). CONCLUSIONS 16 G biopsy needle significantly improved the positive rates and accurately evaluate the nature of lesions, meanwhile did not increase the incidence of complications compared with 18 G biopsy needle.
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Affiliation(s)
- Xue-Fei Ding
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Yang Luan
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - An-le Xia
- Dongtai People's Hospital, Dongtai, China
| | - Liang-Yong Zhu
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Qin Xiao
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Ji Chen
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hao-Peng Chen
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Yue-Xing Han
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Zhong Liu
- Clinical Medical College, Yangzhou University, Yangzhou, China
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Hao S, Karlsson A, Heintz E, Elfström KM, Nordström T, Clements M. Cost-Effectiveness of Magnetic Resonance Imaging in Prostate Cancer Screening: A Microsimulation Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1763-1772. [PMID: 34838274 DOI: 10.1016/j.jval.2021.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to assess the cost-effectiveness of magnetic resonance imaging (MRI) with combinations of targeted biopsy (TBx) and systematic biopsy (SBx) for early prostate cancer detection in Sweden. METHODS A cost-utility analysis was conducted from a lifetime societal perspective using a microsimulation model. Five strategies included no screening and quadrennial screening for men aged 55 to 69 years using SBx alone, TBx on positive MRI (MRI + TBx), combined TBx/SBx on positive MRI (MRI + TBx/SBx), and SBx on negative MRI with TBx/SBx on positive MRI (MRI - SBx, MRI + TBx/SBx). Test characteristics were based on a recent Cochrane review. We predicted the number of biopsies, costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios. RESULTS The screening strategies were classified in Sweden as high costs per QALY gained compared with no screening. Using MRI + TBx and MRI + TBx/SBx reduced the number of biopsy episodes across a lifetime by approximately 40% compared with SBx alone. Both strategies showed strong dominance over SBx alone and MRI - SBx, MRI + TBx. Compared with MRI + TBx, the MRI + TBx/SBx strategy had an incremental cost-effectiveness ratio of more than €200 000 per QALY gained, which was classified in Sweden as a very high cost. These predictions were robust in the probabilistic sensitivity analysis. Limitations included generalizability of the model assumptions and uncertainty regarding the health-state values and study heterogeneity from the Cochrane review. CONCLUSIONS MRI + TBx and MRI + TBx/SBx showed strong dominance over alternative screening strategies. MRI + TBx resulted in similar or marginally lower gains in QALYs and lower costs than MRI + TBx/SBx. MRI + TBx was considered the optimal choice among the screening strategies.
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Affiliation(s)
- Shuang Hao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emelie Heintz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - K Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Danderyd, Sweden
| | - Mark Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Abstract
In research, policy, and practice, continuous variables are often categorized. Statisticians have generally advised against categorization for many reasons, such as loss of information and precision as well as distortion of estimated statistics. Here, a different kind of problem with categorization is considered: the idea that, for a given continuous variable, there is a unique set of cut points that is the objectively correct or best categorization. It is shown that this is unlikely to be the case because categorized variables typically exist in webs of statistical relationships with other variables. The choice of cut points for a categorized variable can influence the values of many statistics relating that variable to others. This essay explores the substantive trade‐offs that can arise between different possible cut points to categorize a continuous variable, making it difficult to say that any particular categorization is objectively best. Limitations of different approaches to selecting cut points are discussed. Contextual trade‐offs may often be an argument against categorization. At the very least, such trade‐offs mean that research inferences, or decisions about policy or practice, that involve categorized variables should be framed and acted upon with flexibility and humility. In practical settings, the choice of cut points for categorizing a continuous variable is likely to entail trade‐offs across multiple statistical relationships between the categorized variable and other variables. These trade‐offs mean that no single categorization is objectively best or correct.
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Affiliation(s)
- Evan L Busch
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Zhang Z, Liang G, Zhang P, Zhao Z, He Z, Luo F, Chen Z, Yang Z, Zhang Z, Xia T, Liu X, Zhang Y, Ye W. China county-based prostate specific antigen screening for prostate cancer and a cost-effective analysis. Transl Androl Urol 2021; 10:3787-3799. [PMID: 34804822 PMCID: PMC8575585 DOI: 10.21037/tau-21-779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background Prostate cancer is one of the most common malignant tumors worldwide, and is the third-leading cause of cancer death in men. Nearly 70% of new prostate cancer patients in China are locally advanced or widely metastatic with poor prognosis. Providing active treatment to early stage prostate cancer patients can improve the prognosis of prostate cancer patients. Thus, this study sought to evaluate the economy of early prostate specific antigen (PSA) screening for high-risk prostate cancer. Methods Based on the data collected from the PSA screening activities of 11 county hospitals from October 2019 to April 2021, this study evaluated a high-risk prostate cancer population who received PSA screening and their quality of life and economy. The screening population comprised males aged over 50 years. All screening patients were tested for PSA. If the PSA value is unnormal, a further diagnosis based on magnetic resonance imagining (MRI) or a transrectal ultrasound-guided prostate biopsy were performed. The decision-tree and Markov model was used to simulate the process of disease development of high-risk prostate cancer patients who underwent screenings and those who did not, and the incremental cost-effectiveness ratio was also evaluated. Results A total of 13,726 men received a PSA screening. Of these, 1,062 men had abnormal PSA values, and 73 of these were diagnosed with prostate cancer. Of these 73 patients, 40, 21, and 12 had early stage, mid-stage, and late-stage prostate cancer, respectively. Compared to the patients unscreened, the 1,000 patients who received an early PSA screening increased their quality-adjusted life year (QALY) by 15.69 years; however, each QALY had an additional cost of 38,550 yuan, which was lower than the willingness to pay threshold of 72,447 yuan (per capita gross domestic product in 2020). Conclusions For high-risk prostate cancer patients, early screenings have a cost-effective advantage over no screenings. Thus, early screening should be vigorously promoted for high-risk prostate cancer patients.
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Affiliation(s)
- Zhiguo Zhang
- Department of Urology, Liuyang People's Hospital, Liuyang, China
| | - Guoshu Liang
- Department of Urology, Guanghan People's Hospital, Guanghan, China
| | - Peng Zhang
- Department of Urology, Xinmi Hospital of T.C.M, Xinmi, China
| | - Zhongqi Zhao
- Department of Urology, Pucheng County Hospital, Weinan, China
| | - Zhongnan He
- Department of Urology, Ruichang People's Hospital, Ruichang, China
| | - Fengzhen Luo
- Department of Urology, The People's Hospital of Yudu County, Ganzhou, China
| | - Zhenqing Chen
- Department of Urology, Xunxian People's Hospital, Hebi, China
| | - Zongke Yang
- Department of Urology, Dianjiang People's Hospital, Dianjiang, China
| | - Zhijie Zhang
- Department of Urology, The Second Hospital of Qinhuangdao, Qinhuangdao, China
| | - Tao Xia
- Department of Urology, Chengcheng County Hospital, Weinan, China
| | - Xin Liu
- Department of General Surgery, Linzhou People's Hospital, Linzhou, China
| | - Yong Zhang
- Department of Urology, Liuyang People's Hospital, Liuyang, China
| | - Wei Ye
- Department of Urology, Guanghan People's Hospital, Guanghan, China
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Qin X, Ye D, Gu C, Huang Y, Gu W, Dai B, Zhang H, Zhu Y, Yang H, Qu S. Prostate Cancer Screening Using Prostate-Specific Antigen Tests in a High-Risk Population in China: A Cost-Utility Analysis. CURRENT THERAPEUTIC RESEARCH 2021; 95:100653. [PMID: 34917218 PMCID: PMC8646126 DOI: 10.1016/j.curtheres.2021.100653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Both National Comprehensive Cancer Network and Chinese guidelines recommend beginning prostate-specific antigen (PSA) screening for men aged 50 years or 45 years with a family history because they were at a higher risk of developing prostate cancer. Several model-based economic evaluations of PSA screening studies have been conducted, but with little evidence from China. OBJECTIVE The aim of this study was to conduct an economic evaluation of the cost-utility of PSA-based prostate cancer screening in Chinese men. METHODS We developed a decision-tree and Markov model in Excel (Microsoft Corp, Redmond, Washington) to compare 2 strategies that can be used to detect prostate cancer: PSA-based screening followed by a biopsy, and non-PSA screening. We assumed that the patients would repeat screening in subsequent years if their first-year PSA value was higher than 4.0 ng/mL. The model adopted health care system perspective and lifetime horizon. Screening efficacy, cost, utility, and long-term survival of prostate cancer were retrieved from published literature and physician surveys. Both quality-adjusted life year and costs were discounted at an annual rate of 3.5%. Uncertainty was assessed by 1-way and probabilistic sensitivity analyses. Our model also calculated the risk-to-benefit ratio as the ratio of overdiagnosis (biopsy without diagnosed) to prostate cancer-related deaths prevented in different age groups. RESULTS The results suggested that PSA-based screening was cost-effective compared with no PSA screening, with an incremental cost-utility ratio of ¥11,381 ($1821/€1480) per quality-adjusted life year. This value was less than the threshold of 1-time gross domestic product per capita in China (ie, ¥70,892 [$11,343/€9216]). Sensitivity analyses confirmed the robustness of the results. The risk-to-benefit ratios of the 50 to 65 years and the 65 to 80 years age groups were 1.3 and 2.8, respectively. CONCLUSIONS PSA-based prostate cancer screening appears to be cost-effective in some high-risk Chinese men. PSA screening (PSA testing followed by magnetic resonance imaging and biopsy if positive) can be recommended for Chinese men aged 50 to 65 years because this approach had the lowest risk-to-benefit ratio. The approach should be further adapted based on future updated data. (Curr Ther Res Clin Exp. 2022; 83:XXX-XXX)© 2022 Elsevier HS Journals, Inc.
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Affiliation(s)
- Xiaojian Qin
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Dingwei Ye
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chengyuan Gu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | | | - Weijie Gu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Bo Dai
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hailiang Zhang
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yao Zhu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Han Yang
- Real World Insights, IQVIA, Shanghai, China
| | - Shuli Qu
- Real World Insights, IQVIA, Shanghai, China
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50
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Albright BB, Myers ER, Moss HA, Ko EM, Sonalkar S, Havrilesky LJ. Surveillance for gestational trophoblastic neoplasia following molar pregnancy: a cost-effectiveness analysis. Am J Obstet Gynecol 2021; 225:513.e1-513.e19. [PMID: 34058170 PMCID: PMC9941751 DOI: 10.1016/j.ajog.2021.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Historically, published guidelines for care after molar pregnancy recommended monitoring human chorionic gonadotropin levels for the development of gestational trophoblastic neoplasia until normal and then for 6 months after the first normal human chorionic gonadotropin. However, there are little data underlying such recommendations, and recent evidence has demonstrated that gestational trophoblastic neoplasia diagnosis after human chorionic gonadotropin normalization is rare. OBJECTIVE We sought to estimate the cost-effectiveness of alternative strategies for surveillance for gestational trophoblastic neoplasia after human chorionic gonadotropin normalization after complete and partial molar pregnancy. STUDY DESIGN A Markov-based cost-effectiveness model, using monthly cycles and terminating after 36 months/cycles, was constructed to compare alternative strategies for asymptomatic human chorionic gonadotropin surveillance after the first normal (none; monthly testing for 1, 3, 6, and 12 months; or every 3-month testing for 3, 6, and 12 months) for both complete and partial molar pregnancy. The risk of reduced surveillance was modeled by increasing the probability of high-risk disease at diagnosis. Probabilities, costs, and utilities were estimated from peer-reviewed literature, with all cost data applicable to the United States and adjusted to 2020 US dollars. The primary outcome was cost per quality-adjusted life year ($/quality-adjusted life year) with a $100,000/quality-adjusted life year willingness-to-pay threshold. RESULTS Under base-case assumptions, we found no further surveillance after the first normal human chorionic gonadotropin to be the dominant strategy from both the healthcare system and societal perspectives, for both complete and partial molar pregnancy. After complete mole, this strategy had the lowest average cost (healthcare system, $144 vs maximum $283; societal, $152 vs maximum $443) and highest effectiveness (2.711 vs minimum 2.682 quality-adjusted life years). This strategy led to a slightly higher rate of death from gestational trophoblastic neoplasia (0.013% vs minimum 0.009%), although with high costs per gestational trophoblastic neoplasia death avoided (range, $214,000 to >$4 million). Societal perspective costs of lost wages had a greater impact on frequent surveillance costs than rare gestational trophoblastic neoplasia treatment costs, and no further surveillance was more favorable from this perspective in otherwise identical analyses. No further surveillance remained dominant or preferred with incremental cost-effectiveness ratio of <$100,000 in all analyses for partial mole, and most sensitivity analyses for complete mole. Under the assumption of no disutility from surveillance, surveillance strategies were more effective (by quality-adjusted life year) than no further surveillance, and a single human chorionic gonadotropin test at 3 months was found to be cost-effective after complete mole with incremental cost-effectiveness ratio of $53,261 from the healthcare perspective, but not from the societal perspective (incremental cost-effectiveness ratio, $288,783). CONCLUSION Largely owing to the rare incidence of gestational trophoblastic neoplasia after human chorionic gonadotropin normalization after molar pregnancy, prolonged surveillance is not cost-effective under most assumptions. It would be reasonable to reduce, and potentially eliminate, current recommendations for surveillance after human chorionic gonadotropin normalization after molar pregnancy, particularly among partial moles. With any reduction in surveillance, patients should be counseled on symptoms of gestational trophoblastic neoplasia and established in routine gynecologic care.
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Affiliation(s)
- Benjamin B Albright
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC.
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | - Haley A Moss
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | - Emily M Ko
- Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, PA
| | - Sarita Sonalkar
- Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, PA
| | - Laura J Havrilesky
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
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