Zhang Zhiguo, Liang Guoshu, Zhang Peng, Zhao Zhongqi, He Zhongnan, Luo Fengzhen, Chen Zhenqing, Yang Zongke, Zhang Zhijie, Xia Tao, Liu Xin, Zhang Yong, Ye Wei
Department of Urology, Liuyang People's Hospital, Liuyang, China.
Department of Urology, Guanghan People's Hospital, Guanghan, China.
Transl Androl Urol. 2021 Oct;10(10):3787-3799. doi: 10.21037/tau-21-779.
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.
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.
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).
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.
前列腺癌是全球最常见的恶性肿瘤之一，是男性癌症死亡的第三大原因。中国近70%的前列腺癌新发病例为局部晚期或广泛转移，预后较差。为早期前列腺癌患者提供积极治疗可改善前列腺癌患者的预后。因此，本研究旨在评估高危前列腺癌早期前列腺特异性抗原（PSA）筛查的经济性。
基于2019年10月至2021年4月11家县级医院PSA筛查活动收集的数据，本研究评估了接受PSA筛查的高危前列腺癌人群及其生活质量和经济性。筛查人群为50岁以上男性。所有筛查患者均进行PSA检测。如果PSA值异常，则基于磁共振成像（MRI）或经直肠超声引导下前列腺穿刺活检进行进一步诊断。采用决策树和马尔可夫模型模拟接受筛查和未接受筛查的高危前列腺癌患者的疾病发展过程，并评估增量成本效益比。
共有13726名男性接受了PSA筛查。其中，1062名男性PSA值异常，其中73人被诊断为前列腺癌。在这73例患者中，分别有40例、21例和12例患有早期、中期和晚期前列腺癌。与未接受筛查的患者相比，接受早期PSA筛查的1000例患者的质量调整生命年（QALY）增加了15.69年；然而，每个QALY的额外成本为38550元，低于意愿支付阈值72447元（2020年人均国内生产总值）。
对于高危前列腺癌患者，早期筛查比不筛查具有成本效益优势。因此，应大力推广对高危前列腺癌患者进行早期筛查。
