Future benefits and cost-effectiveness of prostate carcinoma screening. American Cancer Society.

BACKGROUND

Estimates of cost-effectiveness for prostate carcinoma screening require a review of current data, modeling efforts, and perspectives on societal impact and costs.

METHODS

Recent data from the cancer registry of the Michigan Department of Community Health was assessed for incidence trends in relation to age groups and racial differences. Differences in tumor biology between African-American men (AAM) and white men were assessed from a large clinical biopsy series. A review of the literature addressing Markoff modeling to obtain estimates of treatment, screening efficacy, and costs were evaluated.

RESULTS

The decline in the incidence of prostate carcinoma since 1992 primarily affected men age > 70 years whereas younger men (age 45-70 years) maintained a 100% greater incidence of localized disease than in 1989, when prostate specific antigen screening became more common. The rate of distant disease has decreased by 60% for both age groups. In the current biopsy series, AAM have distinctly more cores involved with carcinoma and have a higher number of carcinoma cores involved with a Gleason score > or = 7 in men age < or = 70 years with a PSA level < or = 10 ng/ mL (P < 0.05). Markoff models reviewed in the literature demonstrated significant sensitivity to progression, complication, and comorbidity rates. Recent models suggested significant increases in quality-adjusted life expectancy for men choosing radical prostatectomy over watchful waiting if they were age < 70 years and had no severe comorbidities. Original cost estimates from benefit-cost analysis showed similar results of cost per carcinoma and cost per quality-adjusted life-year extension as later cost-effectiveness models.

CONCLUSIONS

Current diagnostic trends toward the persistent increased detection of localized prostate carcinoma in younger men, combined with a marked reduction in distant stage disease, suggest significant potential mortality reductions. These trends may have greater implications for AAM, but further research is needed to produce models of mortality reduction from emerging data.