Cost-effectiveness of prostate cancer screening: a protocol for the systematic review of decision-analytical models

There is an ongoing debate about the harms and benefits of implementing a national screening programme for prostate cancer. The screening test (Prostate Specific Antigen, PSA) has poor sensitivity and specificity, meaning it produces a high proportion of false positive and false negative results. The PSA screen is followed by a biopsy which itself has relatively poor sensitivity. The screen test and biopsy are unable to distinguish between aggressive and indolent cancer, which may never cause symptoms within a man’s lifetime. The subsequent radical treatments for screen and biopsy detected prostate cancer may impact significantly on quality of life and resources. The potential benefits of screening are for those men who have aggressive prostate cancer that is destined to progress, because the cancer is identified and treated earlier than in clinical practice, potentially improving life expectancy. Other screen detected men are, on the other hand, subjected to unnecessary tests and radical treatments.