Projecting Benefits and Harms of Novel Cancer Screening Biomarkers: a Study of Pca3 and Prostate Cancer

• Activity Number: 220
• Type: Topic Contributed
• Date/Time: Monday, August 4, 2014 : 2:00 PM to 3:50 PM
• Sponsor: Health Policy Statistics Section
• Author(s): Jeanette Birnbaum*+ and Ziding Feng and Jing Fan and Roman Gulati and Ruth Etzioni
• Companies: University of Washington and MD Anderson Cancer Center and University of Washington and Fred Hutchinson Cancer Research Center and Fred Hutchinson Cancer Research Center
• Keywords: cancer biomarker ; simulation modeling ; prostate cancer ; cancer screening

Abstract

New biomarkers for early detection of cancer must pass through several phases of development to determine their population impact. Simulation modeling can provide early projections of population benefits and harms of a new biomarker given its diagnostic properties. Prostate cancer antigen 3 (PCA3) is a new biomarker that has been shown to improve diagnostic performance when used with prostate specific antigen (PSA) to screen for prostate cancer. Using data from a recent study of PCA3 and PSA distributions in men referred for prostate biopsy, we simulated screening with joint PCA3-PSA strategies designed to improve specificity and reduce overdiagnosis. We modeled the survival benefit of screen detection using a novel cure function with a probability of cure that increases with the earliness of detection. We identified a promising joint strategy PCA3-PSA that retained 85% of lives saved while reducing false positives by 50% and overdiagnoses by 25% compared to the standard PSA-based test. This study demonstrates the relevance of simulation modeling for projecting downstream, policy-relevant outcomes at early stages of biomarker development.