Fig 1.
Schematic of the prostate cancer natural history model reflecting disease onset, progression and survival in the absence of screening.
Individuals are assumed to be healthy at age 35 years; they may progress to preclinical cancer states with fixed Gleason score, but with progression by T-stage and to metastatic cancer; preclinical cancers may be clinically diagnosed from nine different states, with survival from prostate cancer death modelled from the time of clinical diagnosis; death due to other causes is represented as a competing event.
Fig 2.
Modelled current PSA testing rates per person-year for ages 40-80 years and the calendar period 1995-2014 for men without an existing prostate cancer diagnosis.
The white contour lines indicates the rates 0.1, 0.2 and 0.3. The modelled values are based on data from the Stockholm PSA and Biopsy Register [15].
Table 1.
Model inputs and targets used to adapt the model to the Swedish context.
Table 2.
Estimated parameters from calibration procedure.
Fig 3.
Fitted Gleason, T-stage and metastatic proportions of cases in 2011-2013 by age groups to that observed in the SPBR register.
Fig 4.
Simulated survival from the calibrated model displayed as Kaplan-Meier survival curves together with the observed 10- and 15-year survival from PCBaSe displayed as point estimates with 95% confidence intervals.
Survival is stratified by age at diagnosis, PSA at diagnosis, Gleason score and cancer extent.
Fig 5.
Age-standardised prostate cancer incidence rates from the simulation model compared with those observed in Sweden.
Fig 6.
Predicting incidence and overdiagnosis rate ratios for 2-yearly and 8-yearly screening between 55 and 69 years of age and the cessation of asymptomatic testing compared with current testing uptake.
The changes in testing policy were introduced in 2015 for a population reflecting the Swedish age-structure.
Fig 7.
Predicting mortality RRs and life-years gained for 2-yearly and 8-yearly screening between 55 and 69 years of age and the cessation of asymptomatic PSA testing compared with current testing patterns.
The shifts in testing policy was introduced 2015 on a population reflecting the Swedish age-structure.
Fig 8.
Overview of data sources and their linkage.
Fig 9.
Comparing the modelled proportion of Gleason scores at cancer onset from FHCRC model in 2013 and 2018 with the Stockholm Prostata model.