Economic analysis of PSA screening, selective treatment strategies

Can prostate-specific antigen (PSA) screening for prostate cancer be cost-effective? A study, commentary and author interview published online by JAMA Oncology examines that question.

The future of PSA screening is uncertain with the U.S. Preventive Services Task Force's recommendation against routine PSA screening for prostate cancer and conservative guidance from other panels.

Ruth Etzioni, Ph.D., of the Fred Hutchinson Cancer Research Center, Seattle, and coauthors used simulation modeling to examine the potential cost-effectiveness of plausible PSA screening strategies and to assess the value added by increased use of conservative management among low-risk, screening-detected cancer cases.

The study reports that if PSA screening is to be cost-effective, it should be used conservatively and in combination with conservative management for low-risk disease.

"Our findings have clear implications for the future of PSA screening in the United States. Rather than stopping PSA screening, as recommended by the U.S. Preventive Services Task Force, implementation of strategies that extend the screening interval and/or use higher PSA biopsy thresholds have the potential to preserve substantial benefit while controlling harm and costs," the article concludes.