Model favours more personalised screening for prostate cancerBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f711 (Published 06 February 2013) Cite this as: BMJ 2013;346:f711
For a long time the debate about screening for prostate cancer has focused on the trade off between potential benefits (lives saved) and harms (overdiagnosis, overtreatment), although quantifying either is proving difficult. Even large trials are contradictory, and policy makers are increasingly turning to theoretical models to help them decide when to start and stop screening, how often to screen, and which concentration of prostate specific antigen (PSA) should trigger a biopsy.
In a new study modelling 35 different strategies, the best balance of benefits and harms emerged from strategies that raised the trigger threshold in older men or increased the screening interval from one to two years for men with lower PSA concentrations. Both policies preserved most of the mortality benefit, while reducing the risk of overdiagnosis by at least a quarter.
The absolute difference between strategies looked small, however (lifetime risk of dying from prostate cancer varied from 2.02% to 2.43%). At least one commentator thinks the new findings are unlikely to have a big impact on policy (p 211). The model used assumes that screening can definitely save lives, and considerable uncertainty remains about that, he writes.
Cite this as: BMJ 2013;346:f711