Potential impact of a population-based screening program on the increased burden of prostate cancer in Thailand: A simulation study

BackgroundProstate cancer incidence and mortality are expected to increase considerably in the near future in Thailand. There is thus an urgent need to establish prevention measures, such as screening, to reduce the increasing burden of prostate cancer in Thailand. MethodsUsing data from several sources including the Songkhla Cancer Registry and the census data from Thailand, we conducted a simulation analysis to assess the potential impact of screening on the incidence and mortality of prostate cancer among 10 million males aged 50 to 70 of 1960 birth cohort from Songkhla, Thailand. We assumed 4 different scenarios, including no screening, 15%, 60% and 100% screening uptakes of the prostate-specific antigen test. Furthermore, stage distribution of prostate cancer was assumed based on two major prostate cancer screening trials: European Randomized Study of Screening for Prostate Cancer (ERSPC) and Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. The number of prostate cancer cases was projected using an age-period-cohort model approach, accounting for the expected excess of cases due to screening. Deaths from prostate cancer were then projected using survival probabilities from Songkhla and the United States. Case fatality ratios (CFRs) were also computed. ResultsProstate cancer incidence increased with screening, as expected, with a shift of the stage distribution toward earlier stages, but mortality from prostate cancer decreased with higher screening uptake. Assuming 1.71 excess risk of cases due to screening and stage distribution from the ERSPC trial, we projected an increase of over 7,000 localized cases under 100% screening uptake, while the cases in advanced stages decreased from 4,046 (no screening) to 96 under 100% screening uptake. The number of deaths were reduced by 82% under 100% screening uptake compared to no screening. The CFR also decreased from 0.42 (no screening) to 0.05 (100% screening). ConclusionScreening for prostate cancer could substantially reduce the number of prostate cancer cases in advanced stages and prostate cancer deaths. Although the net benefit depends on the assumed survival rates under screening, which could vary depending on the quality of the implementation, screening would contribute to reducing the escalating burden of prostate cancer in Thai population.