Table 1.
Final outcomes for statements after Round 2
| Statement | % Rating 7–9 | % Rating 8–9 | % Rating 1–3 | Outcome: pre-agreed rules | Interrater agreement (r*wg) |
|---|---|---|---|---|---|
| It is useful to compare the cost-effectiveness of no screening to other screening strategies in a future economic model | 88.24 | 88.24 | 0.00 | Consensus reached | 0.90 |
| It is useful to compare the cost-effectiveness of inviting all men within a certain age range to be screened to other screening strategies in a future economic model | 94.12 | 82.35 | 5.88 | Consensus reached | 0.89 |
| If it is possible to identify men at higher risk of developing prostate cancer prior to testing (through the use of polygenic risk scores, family history, ethnicity or otherwise), it would be useful to compare the cost-effectiveness of inviting only higher risk men for screening | 88.24 | 82.35 | 0.00 | Consensus reached | 0.94 |
| If it is possible to identify men at higher risk of developing prostate cancer prior to testing, it would be useful to compare the cost-effectiveness of inviting all men within a certain age bracket for screening but screening higher risk men at an earlier age | 88.24 | 70.59 | 5.88 | Consensus reached | 0.82 |
| PSA in isolation should no longer be used a reflex test to trigger MRI/prostate biopsy | 35.29 | 23.53 | 17.65 | Consensus not reached | 0.75 |
| A PSA test should be used before a more sophisticated biomarker or risk model (e.g. 4k score, STHLM3) and only men with total PSA above a certain threshold should be tested using the biomarker or risk model | 41.18 | 35.29 | 23.53 | Consensus not reached | 0.65 |
| A PSA threshold of 1.5 ng/ml has enough negative predictive value to exclude any further testing | 35.29 | 23.53 | 17.65 | Consensus not reached | 0.65 |
| The threshold for further investigation should increase as men age | 47.06 | 35.29 | 5.88 | Consensus not reached | 0.76 |
| It would be useful to assess the cost-effectiveness of using a multi-kallikrein panel or risk model (e.g. 4k score, STHLM3) as a reflex test to triage patients suitable for mpMRI prior to biopsy | 64.71 | 52.94 | 0.00 | Consensus not reached | 0.87 |
| It would be useful to assess the cost-effectiveness of using PSA density and % free PSA alongside a multi-kallikrein panel as reflex tests to triage patients suitable for mpMRI prior to biopsy | 52.94 | 41.18 | 0.00 | Consensus not reached | 0.89 |
| All men being screened should be offered a DRE | 17.65 | 17.65 | 47.06 | Consensus not reached | 0.59 |
| If it is possible to identify men at higher risk of developing prostate cancer (through the use of polygenic risk scores, family history, ethnicity or otherwise), it would be useful to compare the cost-effectiveness of using different screening intervals for higher and lower risk men | 88.24 | 82.35 | 0.00 | Consensus reached | 0.93 |
| It is useful to compare the cost-effectiveness of using different screening intervals based on PSA level at previous test | 76.47 | 64.71 | 0.00 | Consensus reached* | 0.89 |
DRE digital rectal examination, mpMRI multiparametric magnetic resonance imaging, PSA prostate-specific antigen, STHLM3 Stockholm 3 panel
*This was the only statement for which the outcome under the more stringent rules differed i.e., consensus not reached