TO BE SCREENED OR NOT TO BE SCREENED? THE CONSEQUENCES OF PROSTATE-SPECIFIC ANTIGEN SCREENING FOR THE INDIVIDUAL

Purpose: To present for an individual the estimated benefits and adverse effects associated with the decision to participate in screening.

Method: We used a validated micro-simulation model to simulate the development of prostate cancer and screening for a cohort in which individuals were screened for the first time between the ages of 50 and 70. These individuals were screened until the age of 65, 70 or 75. We analyzed the situation in which there was no screening, screening every year and screening every four years. Survival curves, including prostate-cancer-free survival, were calculated with follow-up time from the time of decision to be screened. For men who had been screened and those who had not, we estimated the lifetime probability of prostate cancer diagnosis and death, and overall and prostate-cancer-free life-expectancy. Using these values we calculated the utility break-even point. This is that value of the utility of living with diagnosed prostate cancer for which the utility-adjusted life-expectancy does not change upon deciding to participate in screening or not.

Result: The effects of participating in screening were estimated to be on average a limited gain in life-expectancy of 0.08 years versus a more substantial loss of 1.53 prostate-cancer-free life-years. The utility break-even point was on average 0.952. This result imply that men who judge that their quality of life will decrease by no more than 4.8% in the event that they are diagnosed and treated for prostate cancer could consider to be screened. From the protocols we analyzed, screening every four years till age 65 had the lowest utility break-even point. Men could consider screening under this protocol if they judge their quality of life to decrease by no more than 7.7% in the event that they are diagnosed and treated for prostate cancer. 

Conclusion: Individuals who decide to be screened might benefit from screening, but the associated potential adverse effects are significant. The decision to be screened should depend on how undesirable it is for the individual to live with diagnosed prostate cancer and the potential side-effects of treatment.