A System Dynamics Model of Serum Prostate-Specific Antigen Screening for Prostate Cancer

摘要

Since 2012, the guidelines recommended against routine prostate-specific antigen (PSA) screening for prostate cancer. However, evidence for screening benefit from Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial and European Randomized Study of Screening for Prostate Cancer (ERSPC) was inconsistent, partly due to differences in noncompliance and contamination. Using system dynamics (SD) modeling, we replicated PLCO trial and extrapolated follow-up to 20 years. We then simulated three scenarios correcting for contamination in PLCO control arm using SEER incidence and survival data prior to PSA-screening era (scenario 1), during PLCO trial-period (scenario 2), and using ERSPC control arm data (scenario 3). In all scenarios noncompliance was corrected using incidence and survival rates of screen-detected men in PLCO screening arm. Both scenarios 1 and 3 showed PSA screening benefit with relative risks of 0.62 (95% CI 0.53, 0.72) and 0.70 (0.59, 0.83) for cancer-specific mortality at 20-year follow-up, respectively. In scenario 2, however, there was no benefit of screening, similar to PLCO published results. This simulation showed that after correcting for noncompliance and contamination, there is potential benefit of PSA screening in reducing prostate cancer mortality. It also demonstrates the utility of SD for synthesizing epidemiologic evidence to inform public policy.