Annual prostate-specific antigen (PSA) screening yields a greater quality-adjusted life expectancy (QALE) among patients who have a high-risk of developing metastatic disease in comparison to unscreened patients, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 54th Annual Meeting.

In addition, a number of individual factors should be a part of the decision-making process about whether or not to regularly undergo PSA screening.

The study created a state transition Markov model to compare QALE in men with and without annual PSA screening in order to provide further guidance on screening and treatment decisions.

In comparing screened versus non-screened patients, the study found a slight benefit to screening with a value of 13.70 quality-adjusted life years (QALYs) and 13.24 QALYs, respectively.

However, the benefit of annual PSA screening diminished with increasing age and was dependent on the probability of eventually developing metastatic cancer and the associated decrease in quality of life.

For patients who had less than a 4.9 percent chance of developing prostate cancer within 10 years, the recommended strategy was to forgo annual screening.

The study indicates that factors contributing to whether or not a patient should be screened include the age and health of the patient and the potential impact of screening and a prostate cancer diagnosis on their quality of life.

The study, though independent from the European Randomized Study of Screening for Prostate Cancer (ERSPC), used findings from the ERSPC study published in The New England Journal of Medicine in 20091 and 20122, which randomized approximately 162,000 men.

Men aged 65 and older were included in the model, and the results from screening were tracked for 25 years. In men who screened positive for prostate cancer, the study assumed that they had clinically-localized, low-risk prostate cancer, and underwent treatment with intensity modulated radiation therapy (IMRT). In men not screened for prostate cancer who presented with localized disease, the study also assumed they had low-risk disease and underwent subsequent treatment with IMRT. Long-term treatment-related adverse effects included the possibility of developing genitourinary toxicity, gastrointestinal toxicity and sexual dysfunction.

“Our model suggests, that for certain subgroups of men, there may be a quality of life benefit from annual prostate cancer screening and subsequent treatment with radiation therapy,” said Arie P. Dosoretz, MD, lead author of the study and a radiation oncologist at Yale-New Haven Hospital, in New Haven, Conn. “Decision-making about whether men should or should not be screened is complex and nuanced and should be made on an individual basis, with careful consideration of the patient’s age, and the potential impact of diagnosis and treatment on their quality of life.”

The abstract, “A Decision Analysis to Assess the Value of Prostate Cancer Screening: A Shift in Focus from Prostate Cancer Specific Mortality to Distant Metastasis Free Survival,” will be presented in detail during a scientific session at ASTRO’s 54th Annual Meeting.

Source: ASTRO