PhD defence A.M. (Abraham) Getaneh

Prostate cancer is the second most commonly diagnosed cancer and the 5th leading cause of cancer mortality in men across the world. In Europe the disease has become the second frequent cause of cancer-related death in men behind lung cancer. Despite these facts, and various studies showed the benefit of PSA screening on prostate cancer mortality reduction, a population-based prostate cancer screening program has not yet been introduced in almost all countries, in contrast with breast, cervical, and colorectal cancers. However, there is high uptake of opportunistic PSA testing in many countries. This form of screening is usually less efficient and accompanied by a high risk of overdiagnosis.

Important questions, like at what age PSA screening should start, at what age it should stop, and at what frequency to screen, remain debatable and need to be explored more. Furthermore, assessing the effects of triage tests, like MRI, for reduction of the harms of prostate cancer screening can have a profound impact. Cost is another important factor that policy-makers need to consider to implement a given strategy. However, finding the optimal screening strategy that can lead to a better balance between the harms and benefits would require comparisons of various alternative screening strategies, which is impossible to do in a single randomized controlled trial (RCT). Additionally, RCTs generally have limited follow-up time and due to this it is impossible to assess the long-term effects of screening such as overdiagnosis, overtreatment and life-years gained. This is particularly true for prostate cancer where the lead time is often long. Therefore, modeling can play a crucial role for bridging the gap between published evidence and the information we need to develop guidelines, as seen, for example, in breast and colorectal cancer screening.

Throughout this thesis, the MIcro Simulation SCreening ANalysis (MISCAN) model for prostate cancer was used to assess the effects of prostate cancer screening, particularly at a population level. The first part of this thesis describes how modeling can play a crucial role in policy decision making process regarding (prostate) cancer screening. Furthermore, we assessed an optimal prostate cancer screening strategy at a population level by comparing several alternative screening strategies. In the second part of the thesis we evaluated the effects of using MRI in prostate cancer screening and its cost effectiveness in a population screening setting. In the third part, we Introduced a prostate risk calculator that includes long-term harms and benefits of PSA-based prostate cancer screening.

The public defence will take place at the Senate Hall, 1st floor Erasmus Building, location campus Woudestein. The ceremony will begin exactly at 13.00 PM. In light of the solemn nature of the ceremony, we recommend that you do not take children under the age of 6 to the first part of the ceremony.