Prostate cancer constitutes an essential public health issue, as it is a major cause of male deaths. Early detection through an organised testing program with the prostate-specific antigen (PSA) test and systematic biopsy is not in place in most countries due to the risk of over-diagnosis and over-treatment of low-risk cancers. Now there are two proposed approaches to tackle this problem; magnetic resonance imaging (MRI) and the serum-based reflex test “Stockholm3”.
In her thesis, Shuang Hao at the Department of Medical Epidemiology and Biostatistics, aimed to characterise the societal economic burden due to prostate cancer in Sweden and assess the cost-effectiveness of prostate cancer testing using MRI with or without the reflex Stockholm3 test.
What are the most important results in your thesis?
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–The cost-of-illness study found a substantial economic burden for prostate cancer in Sweden, with the main costs from the direct healthcare and informal care provided to the patients. Our results now provide reference values for future cost-effectiveness analyses of prostate cancer screening and treatment. The cost-effectiveness assessments showed that the incorporation of MRI to the PSA screening every 4th year for men age 55-69 years with or without a so called reflex Stockholm3 is associated with reductions in prostate cancer mortality and over-diagnosis of low risk cancers, higher quality-adjusted life years (QALY), incremental cost-effectiveness ratios that are classified as a moderate cost per QALY gained in Sweden, and higher probability to be cost-effective than the traditional PSA screening. My thesis highlights that MRI-based screening may be considered the optimal option for early detection of prostate cancer in Sweden.
Why did you choose to study this particular area?
–Worldwide, prostate cancer screening is only available in Lithuania and Kazakhstan. The major concern is that the widely used PSA testing is accompanied by a large number of unnecessary biopsies, over-diagnosis of low risk cancers and over-treatment. Prostate cancer is the most common form of male cancer in Sweden which has caused a substantial disease burden. With more advanced and more costly diagnosis technologies such as the Stockholm3 test and MRI showing evidence on the improved sensitivity and specificity, there was strong need to assess whether these emerging technologies can be effective and cost-effective for early detection of prostate cancer in the Swedish setting and can thus be considered as an option in forming a national screening programme. This has been driving me with devotion to find the answers.