Benefit of PSA screening diminished in an analysis of ERSPC data using QALYs

A new analysis quantified the effects of prostate-specific antigen (PSA) screening on men's quality of life.

Researchers used follow-up data from the European Randomized Study of Screening for Prostate Cancer (ERSPC) to predict how PSA screening would affect prostate cancer diagnoses, deaths, treatments and men's quality-adjusted life-years.

The results were published in the Aug. 16 New England Journal of Medicine.

The simulation found that if 1,000 men were PSA-screened annually between the ages of 55 and 69, the result would be nine fewer deaths from prostate cancer (a 28% reduction), 14 fewer men receiving palliative therapy (35% reduction) and a total gain of 73 life-years (an average of 8.4 life-years for every avoided death).

When the researchers adjusted those life-years to account for the negative effects of treatment and diagnosis, they concluded that 56 quality-adjusted life-years (QALYs) were gained by screening (range, −21 to 97). Adding men age 70 to 74 to the screening population would increase the overall number of life-years gained to 82, but would not change the number of QALYs.

Overdiagnosis of prostate cancer was the largest contributor to the difference between life-years and QALYs. The researchers called for development of strategies to reduce overdiagnosis and identify aggressive cancers, as well as consideration of comorbidity status in screening decisions. The current evidence is insufficient to make universal recommendations about PSA screening, they said.

“It is essential to await longer follow-up data from the ERSPC, as well as longer-term data on how treatment and active surveillance affect long-term quality of life,” they wrote.

However, the study could “show the way to a resolution of the long-standing controversy about screening,” according to an accompanying editorial. The study shows that the benefits and harms of screening can be quantified in a single measure and weighed based on how a man would value his life in various health states. Further research would be needed to assess this measure on a universal scale, but right now, shared decision making about PSA screening can allow for consideration of patients' potential gain or loss in quality-adjusted life, the editorial said.