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Paper text:
the benefits and harms of prostate - specific antigen ( psa ) testing depend on its performance in detecting prostate cancers and on the benefits of consequent early treatment .
the performance of psa testing as a screening test depends on the cutoff level for recommending a biopsy , the compliance to a biopsy recommendation , and the diagnostic accuracy of the biopsies that are performed .
translating the results of a prostate cancer screening trial to a population setting requires a comparison of psa screening performance for the detection of prostate cancer in these two situations .
a microsimulation screening analysis model for prostate cancer and psa screening was developed for the european randomized study of screening for prostate cancer ( erspc)rotterdam trial and then adapted to the us population by replacing demography parameters with us - specific ones and the trial screening protocol with the frequency of psa tests in the us population .
the natural progression of prostate cancer and the sensitivity of a psa test followed by a biopsy were assumed to be the same in the united states as in the trial .
the model - predicted prostate cancer incidence peak in the united states was substantially higher than the observed prostate cancer incidence peak .
however , the actual observed incidence was reproduced by assuming a substantially lower psa test sensitivity in the united states than in erspc  rotterdam .
psa screening in the united states detected fewer prostate cancers than psa screening in the european trial because of the lower sensitivity of psa testing followed by biopsy .
other factors that differed between the us and erspc  rotterdam populations and might influence the detection rates were not taken into account . the model used for the frequency of psa testing included diagnostic tests .
the model did not explain the steep drop in prostate cancer incidence in the united states after 1992 .
the benefits and harms of prostate - specific antigen ( psa ) testing depend on its performance in detecting prostate cancers and on the benefits of consequent early treatment .
the performance of psa testing as a screening test depends on the cutoff level for recommending a biopsy , the compliance to a biopsy recommendation , and the diagnostic accuracy of the biopsies that are performed .
translating the results of a prostate cancer screening trial to a population setting requires a comparison of psa screening performance for the detection of prostate cancer in these two situations .
a microsimulation screening analysis model for prostate cancer and psa screening was developed for the european randomized study of screening for prostate cancer ( erspc)rotterdam trial and then adapted to the us population by replacing demography parameters with us - specific ones and the trial screening protocol with the frequency of psa tests in the us population .
the natural progression of prostate cancer and the sensitivity of a psa test followed by a biopsy were assumed to be the same in the united states as in the trial .
the model - predicted prostate cancer incidence peak in the united states was substantially higher than the observed prostate cancer incidence peak .
however , the actual observed incidence was reproduced by assuming a substantially lower psa test sensitivity in the united states than in erspc  rotterdam .
psa screening in the united states detected fewer prostate cancers than psa screening in the european trial because of the lower sensitivity of psa testing followed by biopsy .
other factors that differed between the us and erspc  rotterdam populations and might influence the detection rates were not taken into account .
the model did not explain the steep drop in prostate cancer incidence in the united states after 1992 .
national cancer institute ( u01-ca88160 to h.k . ) and netherlands organization for health research and development ( zonmw ) .
dissemination of prostate - specific antigen ( psa ) testing in the united states coincided with an increasing incidence of prostate cancer , a shift to earlier stage disease at diagnosis , and decreasing prostate cancer mortality . 
 we compared psa screening performance with respect to prostate cancer detection in the us population vs in the rotterdam section of the european randomized study of screening for prostate cancer ( erspc  rotterdam ) . 
 we developed a simulation model for prostate cancer and psa screening for erspc  rotterdam . 
 this model was then adapted to the us population by replacing demography parameters with us - specific ones and the screening protocol with the frequency of psa tests in the us population . 
 we assumed that the natural progression of prostate cancer and the sensitivity of a psa test followed by a biopsy were the same in the united states as in erspc  rotterdam . 
 the predicted prostate cancer incidence peak in the united states was then substantially higher than the observed prostate cancer incidence peak ( 13.3 vs 8.1 cases per 1000 man - years ) . 
 however , the actual observed incidence was reproduced by assuming a substantially lower psa test sensitivity in the united states than in erspc  rotterdam . 
 for example , for nonpalpable local- or regional - stage cancers ( ie , stage t1m0 ) , the estimates of psa test sensitivity were 0.26 in the united states vs 0.94 in erspc  rotterdam . 
 we conclude that the efficacy of psa screening in detecting prostate cancer was lower in the united states than in erspc  rotterdam .