Australian Prostate Cancer Collaboration

New cases of prostate cancer, 2015, UK
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Deaths from prostate cancer, 2014, UK

In summary, an approach to PSA based prostate cancer screening has to take into account the controversies surrounding available data and the fact that over a decade the benefits are modest in terms of prostate cancer deaths averted; 1 death per 1,000 men screened in the ERSPC.7 However the relative benefit (20% reduction in disease-specific deaths) could be very meaningful at the population level. The potential benefits of screening could extend beyond survival as a primary outcome, and will depend on the relevant time horizon for an individual. Further, disconnecting screening from automatic treatment will significantly impact the risk benefit ratio.

Survive prostate cancer for 10 or more years, 2010-11, England and Wales
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The for prostate cancer is ICD-10 C61.

The second use of models has been to interpret trends in prostate cancer mortality under screening. Prostate cancer death rates in the US began to decline in the early 1990s and by 2009 had dropped by more than 40% since their peak in the early 1990s.38 Since PSA screening disseminated into population practice before trials of screening efficacy were mature, these evolving trends in population death rates provided a natural experiment for interrogating PSA screening benefit. However, it has been difficult to disentangle the effects of screening from the effects of changes in primary treatment that have occurred since the mid-1980s. These changes have primarily included increased use of radical prostatectomy for clinically localized disease, the ability to deliver greater doses of radiation to the prostate and the advent of neoadjuvant and adjuvant hormonal therapies.

20. Schröder FH, Hugosson J, Roobol MJ, et al. Prostate-cancer mortality at 11 years of follow-up.  ;366:-
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24. Klotz L, Vesprini D, Sethukavalan P, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. ;33:-

27. Graham J, Kirkbride P, Cann K, Hasler E, Prettyjohns M. Prostate cancer: summary of updated NICE guidance.  ;348:-
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Prostate Cancer Center: Treatments, Symptoms, …

The primary outcome measure was prostate-cancer mortality at a median of 10 years of follow-up, with prostate-cancer–related deaths defined as deaths that were definitely or probably due to prostate cancer or its treatment. The process for ascertaining cause of death was adapted from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC). The independent cause-of-death evaluation committee, whose members were unaware of the treatment assignments, reviewed summaries of anonymized records. Deaths were categorized as definitely, probably, possibly, probably not, or definitely not due to prostate cancer.

Prostate cancer: Symptoms, treatment, and causes

Estimates of the fraction of screen-detected cases that are overdiagnosed range from 23% to 42%. The estimate of 23% is the same as the estimate obtained in a different study41 that used a very different model, but the same SEER incidence data to estimate the frequency of overdiagnosis in the US. The estimate of 42% is based on a model43 initially derived using data from the Rotterdam section of ERSPC. In that study, the frequency of overdiagnosis among screen-detected cases was 50%, but the likelihood that a screen-detected case has been overdiagnosed can vary from less than 5% to more than 75% depending on the age at diagnosis, the PSA level and the grade of the prostate biopsy.44

Key Statistics for Prostate Cancer | Prostate Cancer Facts

Modeling studies are used to supplement observed data on cancer outcomes by filling in the latent process of disease progression based on observed data on disease incidence under screening. By virtue of the fact that models address the latent process of disease progression they can provide information on unobservable aspects of the process. Thus, for example, models have provided estimates of the time by which screening advances prostate cancer diagnosis and of the frequency of overdiagnosis associated with PSA screening.25,41 Models have also been used to quantify the role of PSA screening in explaining population declines in prostate cancer mortality42 thereby providing indirect evidence about screening benefit that is complementary to that obtained from randomized trials. Finally, models have been used to interrogate the vast array of potential PSA-based screening policies to identify those that are most likely to preserve benefit while reducing adverse outcomes and costs.8