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A stochastic model for survival of early prostate cancer with adjustments for leadtime, length bias, and over-detection.

Authors
  • Wu, Grace Hui-Min
  • Auvinen, Anssi
  • Yen, Amy Ming-Fang
  • Hakama, Matti
  • Walter, Stephen D
  • Chen, Hsiu-Hsi
Type
Published Article
Journal
Biometrical journal. Biometrische Zeitschrift
Publication Date
Jan 01, 2012
Volume
54
Issue
1
Pages
20–44
Identifiers
DOI: 10.1002/bimj.201000107
PMID: 22213054
Source
Medline
License
Unknown

Abstract

To compare the survival between screen-detected and clinically detected cancers, we applied a series of non-homogeneous stochastic processes to deal with leadtime, length bias, and over-detection by using full information on detection modes obtained from the Finnish randomized controlled trial for prostate cancer screening. The results show after 9-year follow-up the hazard ratio of prostate cancer death for screen-detected cases against clinically detected cases increased from 0.24 (95% CI: 0.16-0.35) without correction for these biases, to 0.76 after correction for leadtime and length biases, and finally to 1.03 (95% CI: 0.79-1.33) for a further adjustment for over-detection. Adjustment for leadtime and length bias but no over-detection led to a 24% reduction in prostate cancer death as a result of prostate-specific antigen test. The further calibration of over-detection indicates no gain in survival of screen-detected prostate cancers (excluding over-detected case as stayer considered in the mover-stayer model) as compared with the control group in the absence of screening that is considered as the mover. However, whether the model assumption on over-detection is robust should be validated with other data sets and longer follow-up.

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