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Table 3 Screening with biennial active surveillance follow-up - model predictions for men with average and elevated familial PCa risk

From: Benefits and harms of prostate cancer screening – predictions of the ONCOTYROL prostate cancer outcome and policy model

 

No screening

One-time screening at age

Interval screening at age 55–59, with interval

Interval screening at age 55–64, with interval

Interval screening at age 55–69, with interval

55y

59y

64y

69y

4y (2 x)

2y (3 x)

1y (5 x)

4y (3 x)

2y (5 x)

1y (10 x)

4y (4 x)

2y (8 x)

1y (15 x)

Predictions for men with average PCa risk

 Follow-up biopsies per man under active surveillance (n)

-

6.7

5.3

3.9

1.8

5.7

5.6

5.5

4.8

4.7

4.4

3.9

3.4

3.4

 Lifetime prob. of curative local treatment (%)

4.86

5.17

5.39

5.81

6.37

5.55

5.66

5.85

6.09

6.27

6.90

6.84

7.65

8.45

 Lifetime prob. of curative regional treatment (%)

1.62

1.88

2.08

2.46

2.94

2.12

2.11

2.08

2.45

2.34

2.23

2.89

2.76

2.34

 Lifetime prob. of curative loco/regional treatment (%)

6.48

7.05

7.46

8.27

9.32

7.67

7.77

7.93

8.54

8.61

9.12

9.73

10.40

10.79

 Lifetime risk of curative overtreatment (%)

-

0.57

0.98

1.79

2.84

1.19

1.29

1.45

2.06

2.13

2.64

3.25

3.92

4.31

 Curative overtreatment in screen-detected PCa (%)

-

39.04

38.74

39.34

38.53

36.73

34.31

34.36

35.64

31.93

31.73

34.76

29.41

29.60

 Lifetime risk of dying of PCa (%)

1.72

1.69

1.68

1.66

1.65

1.66

1.65

1.64

1.62

1.61

1.56

1.57

1.52

1.47

 Lifetime gained v. no screening (days)

-

0.7

0.7

1.9

1.9

1.2

1.0

1.0

1.9

1.9

3.9

3.9

5.1

7.1

QALDs gained v. no screening

-

−0.5

−0.9

−1.0

−2.1

−1.2

−1.9

−2.7

−2.0

−2.9

−3.6

−2.3

−3.7

−4.9

 RP-related deaths per 10,000 men (n)

0.70

0.76

0.81

0.86

0.94

0.83

0.83

0.87

0.90

0.91

1.04

1.02

1.15

1.26

 RP- and RT-related AEs per man (n)

0.029

0.031

0.032

0.035

0.039

0.033

0.034

0.035

0.037

0.038

0.041

0.042

0.047

0.051

 PSA tests needed to avoid 1 death (n)

-

4042

2251

1511

1145

3245

4098

5860

2742

3895

5482

2371

3278

4807

 Men needed to be screened to avoid one death (n)

-

4042

2251

1511

1145

1663

1408

1218

966

831

596

651

467

370

Predictions for men with elevated familial PCa risk

 Follow-up biopsies per man under active surveillance (n)

-

5.9

4.8

3.6

1.7

5.1

4.9

4.7

4.3

4.1

3.8

3.5

3.1

2.9

 Lifetime prob. of curative local treatment (%)

8.61

9.00

9.29

9.81

10.47

9.52

9.69

9.99

10.27

10.59

11.57

11.28

12.56

13.87

 Lifetime prob. of curative regional treatment (%)

3.69

4.10

4.40

4.98

5.64

4.48

4.46

4.40

5.02

4.84

4.61

5.71

5.44

4.70

 Lifetime prob. of curative loco/regional treatment (%)

12.29

13.10

13.69

14.79

16.11

14.01

14.16

14.39

15.29

15.43

16.19

16.99

18.00

18.57

 Lifetime risk of curative overtreatment (%)

-

0.81

1.40

2.50

3.82

1.72

1.87

2.10

3.00

3.14

3.90

4.70

5.71

6.28

 Curative overtreatment in screen-detected PCa (%)

-

41.12

41.67

42.23

41.16

39.36

36.88

36.84

38.51

34.70

34.39

37.51

31.85

31.93

 Lifetime risk of dying of PCa (%)

4.35

4.29

4.25

4.20

4.18

4.20

4.18

4.14

4.09

4.05

3.93

3.97

3.82

3.68

 Lifetime gained v. no screening (days)

-

3.5

4.7

6.2

5.4

7.1

8.0

9.7

10.8

12.8

18.0

15.3

20.6

26.3

QALDs gained v. no screening

-

1.8

2.2

2.0

0.0

3.5

3.7

4.2

4.8

5.6

7.3

6.3

8.0

9.5

 RP-related deaths per 10,000 men (n)

1.32

1.39

1.44

1.49

1.59

1.47

1.48

1.53

1.57

1.60

1.74

1.72

1.90

2.07

 RP- and RT-related AEs per man (n)

0.052

0.055

0.058

0.062

0.067

0.059

0.060

0.062

0.065

0.066

0.072

0.072

0.079

0.086

 PSA tests needed to avoid 1 death (n)

-

1429

843

560

429

1196

1535

2055

1015

1417

1962

873

1192

1747

 Men needed to be screened to avoid one death (n)

-

1429

843

560

429

615

531

431

360

306

217

243

173

138

  1. Results are based on individual level simulation (microsimulation) with 10 million trials. Time horizon = 120 years, Compliance = 100%, Active surveillance interval = 2 years. PCa prostate cancer, QALD quality-adjusted life day, RP radical prostatectomy, RT radiotherapy, AE adverse event
  2. QALDs were primary benefit-harm outcome was indicated in bold