Over‐diagnosis and under‐diagnosis of screen‐ vs non‐screen‐detected prostate cancers with in men with prostate‐specific antigen levels of 2.0–10.0 ng/mL

Abstract

OBJECTIVES To evaluate possible over‐ and under‐diagnosis of prostate cancer in a screened vs a referral population in the same range of prostate‐specific antigen (PSA). PATIENTS AND METHODS In all, 1445 patients undergoing radical prostatectomy and with a PSA level of <10 ng/mL were evaluated; 237 were from outside Tyrol (Austria) and represented the unscreened group, and 1208 were Tyrolean screening volunteers. Over‐diagnosis was defined as a pathological stage of pT2a and a Gleason score of <7 with no positive surgical margins. Under‐diagnosis was defined as a pathological stage of ≥pT3a or positive surgical margins. The chi‐square test was used to assess the differences, with P < 0.05 considered to indicate statistical significance. RESULTS There were no significant differences in patient age or PSA levels between the study groups. There was over‐diagnosis in the screening and referral groups in 17.4% and 8.9%, respectively, and under‐diagnosis in 18.6% and 42.2%, respectively. CONCLUSION This study suggests that patients with prostate cancer participating in a screening programme are less likely to be under‐diagnosed or have extracapsular disease than their counterparts in a referral population, even in the same PSA range, after radical prostatectomy. Furthermore, there was more under‐diagnosis in the referral group than over‐diagnosis in the screened group.

Prostate-specific antigen testing in Tyrol, Austria: prostate cancer mortality reduction was supported by an update with mortality data up to 2008

“…Pelzer analyzed 1,445 consecutive patients undergoing radical prostatectomy at the Department of Urology of Innsbruck Medical University and concluded that the rate of overdiagnosis is small (between 8 and 17%), but also noticed underdiagnosis (Pelzer 2008). …”

Overdiagnosis and Overtreatment of Prostate Cancer

“…For example, Pelzer reported significantly less underdiagnosis (defined as pathologic stage T3+ or a positive surgical margin) in screened men compared with nonscreened men [50–52]. Postma et al compared treatment patterns and pathologic features between men from rounds 1 and 2 of the Rotterdam ERSPC [53].…”

Trends in Prostate-specific Antigen Screening, Prostate Biopsies, Urology Visits, and Prostate Cancer Treatments From 2000 to 2012

“…1,2 However, the general consensus is that use of PSA in men older than 75 is not warranted given their limited life expectancy, potential for being over treated and experiencing side-effects of treatment. 3,4,5 In 2008, The US Preventive Services Task Force recommended against screening men ages 75 years and older, citing the limited benefit of screening in a population with a life expectancy of only 10 years on average. 6 In 2011, they went one step further, issuing a grade D recommendation against the already diffuse PSA screening for prostate cancer.…”