Empirical estimates of prostate cancer overdiagnosis by age and prostate-specific antigen

Background: Prostate cancer screening depends on a careful balance of benefits, in terms of reduced prostate cancer mortality, and harms, in terms of overdiagnosis and overtreatment. We aimed to estimate the effect on overdiagnosis of restricting prostate specific antigen (PSA) testing by age and baseline PSA.Methods: Estimates of the effects of age on overdiagnosis were based on population based incidence data from the US Surveillance, Epidemiology and End Results database. To investigate the relationship between PSA and overdiagnosis, we used two separate cohorts subject to PSA testing in clinical trials (n = 1,577 and n = 1,197) and a population-based cohort of Swedish men not subject to PSA-screening followed for 25 years (n = 1,162).Results: If PSA testing had been restricted to younger men, the number of excess cases associated with the introduction of PSA in the US would have been reduced by 85%, 68% and 42% for age cut-offs of 60, 65 and 70, respectively. The risk that a man with screen-detected cancer at age 60 would not subsequently lead to prostate cancer morbidity or mortality decreased exponentially as PSA approached conventional biopsy thresholds. For PSAs below 1 ng/ml, the risk of a positive biopsy is 65 (95% CI 18.2, 72.9) times greater than subsequent prostate cancer mortality.Conclusions: Prostate cancer overdiagnosis has a strong relationship to age and PSA level. Restricting screening in men over 60 to those with PSA above median (>1 ng/ml) and screening men over 70 only in selected circumstances would importantly reduce overdiagnosis and change the ratio of benefits to harms of PSA-screening

LEADER-6: Baseline renal function and associated factors in a high cardiovascular risk type 2 diabetes population

Aims: To examine the prevalence of chronic kidney disease (CKD) and its associated factors in a multinational population with type 2 diabetes mellitus (T2DM) and prior cardiovascular disease (CVD)

The diversity of adaptation in a multilevel governance setting.

This chapter provides an overview of climate change adaptation across Europe, from an interdisciplinary and multidisciplinary perspective, drawing on key findings from case study-based research on local climate change impacts and adaptation solutions, including an analysis of participatory, economic, and sociopolitical approaches, methodologies, and tools. Structured in six sections, the chapter builds upon a set of analytical discussions regarding: the diversity of climate change impacts and adaptation solutions at the local level; the role of participatory methods and approaches; the results of economic evaluation methods and models applied to local case studies; a framework for identifying best practices and characterizing the key barriers and opportunities for implementing local strategies and plans; and a set of robust guidelines and evaluation criteria for climate change adaptation measures. Key findings highlight the intricacies of local-level adaptation utilizing robust examples from case studies across European regions, and provide a comprehensive analysis of local strategies and plans, from a multilevel, multiactor, and multiscale perspective. The chapter also discusses and presents a set of methodological approaches that can be applied to facilitate local-level adaptation while also providing an analytical framework for comparing and evaluating local climate change adaptation