Risk-Based Approach Could Help Target Prostate Cancer Screening

Risk-tailored screening could potentially reduce overdiagnosis and improve the cost-effectiveness of a prostate cancer screening program, according to a study published online December in PLOS Medicine.

Tom Callender, M.B.Ch.B., from University College London, and colleagues examined the benefit-harm trade-offs and cost-effectiveness of a risk-tailored screening program compared to age-based and no screening in a hypothetical cohort of 4.48 million men in England aged 55 to 69 years with follow-up to age 90.

The researchers found that during 35 years of follow-up, age-based screening prevented the most deaths from prostate cancer compared with no screening (39,272) at the expense of 94,831 overdiagnosed cancers. The least cost-effective strategy was age-based screening. Risk-based screening at a 10-year absolute risk threshold of 4 percent generated the greatest number of quality-adjusted life years (QALYs). At this threshold, compared with age-based screening, risk-based screening led to one-third fewer overdiagnosed cancers (64,384 cancers) but averted 6.3 percent fewer deaths from prostate cancer. Risk-based screening at a 4 percent 10-year absolute risk threshold was cost-effective in 48.4 and 57.4 percent of the simulations at willingness-to-pay thresholds of £20,000 ($26,000) and £30,000 ($39,386) per QALY, respectively, compared with no screening. As the threshold increased, the cost-effectiveness of risk-tailored screening improved.

"Precision screening based on age and polygenic risk-profile would improve the benefit-to-harm trade-off and cost-effectiveness of a screening program for prostate cancer," the authors write.

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