Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
JAMA Health Forum. 2022 May 20;3(5):e221116. doi: 10.1001/jamahealthforum.2022.1116. eCollection 2022 May.
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.
To evaluate the expected population outcomes and resource use of conservative prostate-specific antigen screening programs in the Bahamas.
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.
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.
Projected numbers of tests and biopsies, prostate cancer (over)diagnoses, lives saved, and life-years gained owing to screening from 2022 to 2040.
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).
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.
前列腺特异性抗原筛查的益处可能在高危人群中最大，包括加勒比地区的非洲裔男性。然而，在低收入和中等收入国家，有组织的筛查可能无法持续。
评估巴哈马前列腺特异性抗原筛查计划的预期人群结果和资源利用情况。
设计、地点和参与者：使用 GLOBOCAN 的前列腺癌发病率和来自巴哈马的 4300 名男性的前列腺特异性抗原筛查数据，重新校准了之前用于研究美国黑人前列腺特异性抗原筛查的 2 个决策分析模型。使用了 2004 年至 2018 年在拿骚进行的前列腺特异性抗原筛查测试和 2013 年至 2018 年在自由港进行的年龄和结果数据。数据分析于 2021 年 1 月 15 日至 2022 年 3 月 23 日进行。
对 45 至 60 岁的男性进行一次或两次筛查，并采用保守的活检标准（前列腺特异性抗原水平>10ng/ml）和根治性治疗（Gleason 评分≥8）进行建模。Gleason 评分的类别为 6 或更低、7 和 8 或更高，评分越高表示癌症进展和死亡的风险越高。
从 2022 年至 2040 年，由于筛查而进行的检测和活检数量、前列腺癌（过度）诊断、挽救的生命和获得的生命年数。
在这项决策分析建模研究中，使用了来自巴哈马两个地点（中位数年龄 54 岁；范围 13-101 岁）在 2004 年至 2018 年期间接受检测的 4300 名男性的筛查史来为模型提供信息。60 岁时进行一次筛查预计将涉及 40000 至 42000 次检测（模型之间的范围），并预防 10000 至 14000 例前列腺癌死亡中的 500 至 600 例。50 岁和 60 岁时的筛查使检测次数增加了一倍，但挽救的生命仅增加了 15%至 16%。在单次筛查策略中，60 岁时单次筛查涉及到每挽救一条生命所需的检测次数（74-84 次）和每挽救一条生命所需的根治性治疗次数（1.2-2.8 次）最少。
这项关于巴哈马前列腺癌筛查的决策分析建模研究的结果表明，有限的筛查带来了适度的益处，这些益处因筛查年龄和检测次数而异。这些结果可以与能力限制数据结合，并相对于竞争的国家公共卫生重点进行评估。
