Under Diagnosis and Over Diagnosis of Prostate Cancer in a Screening Population With Serum PSA 2 to 10 ng/ml

Pelzer, Alexandre; Bektic, Jasmin; Akkad, Thomas; Schaefer, Georg; Schwentner, Christian; Frauscher, Ferdinand; Bartsch, Georg; Horninger, Wolfgang

doi:10.1016/j.juro.2007.03.021

Cited by 29 publications

(21 citation statements)

References 18 publications

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“…Under diagnosis was defined as pathological stage pT3 or greater, or positive surgical margins. 7 Blood serum samples were obtained before any prostatic manipulation and they were evaluated at our laboratory on the same day. PSA was assessed with the IMx immunoassay.…”

Section: Methodsmentioning

confidence: 99%

Upgrading of Gleason score 6 prostate cancers on biopsy after prostatectomy in the low and intermediate tPSA range

Colleselli

Pelzer

Steiner

et al. 2009

Prostate Cancer Prostatic Dis

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When offering watchful waiting or active monitoring protocols to prostate cancer (PCa) patients, differentiation between Gleason scores (GS) 6 and 7 at biopsy is important. However, upgrading after prostatectomy is common. We investigated the impact of different PSA levels on misclassification in the PSA range of 2-3.9 and 4-10 ng ml À1. A total of 448 patients with GS 6 PCa on prostate biopsy were evaluated by comparing biopsy and prostatectomy GS. Possible over diagnosis was defined as GS o7, pathological stage pT2a and negative surgical margins, and possible under diagnosis was defined as pT3a or greater, or positive surgical margins; the percentage of over-or under diagnosis was determined for correctly and upgraded tumors after prostatectomy. A match between biopsy and prostatectomy GS was found in 210 patients (46.9%). Patients in the PSA range of 2.0-3.9 and 4.0-10.0 ng ml À1 were upgraded in 32.6 and 44.0%, respectively. Over diagnosis was more common than under diagnosis (23.2% vs 15.6%). When upgraded there was a significant increase in under diagnosis. As almost 40% of GS 6 tumors on biopsy are GS 7 or higher after surgery with a significant rise in under diagnosis there is a risk of misclassification and subsequent delayed or even insufficient treatment, when relying on favorable biopsy GS.

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Section: Methodsmentioning

confidence: 99%

Upgrading of Gleason score 6 prostate cancers on biopsy after prostatectomy in the low and intermediate tPSA range

Colleselli

Pelzer

Steiner

et al. 2009

Prostate Cancer Prostatic Dis

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“…In younger men, who are most likely to benefit from early diagnosis and treatment, the criteria for defining over-diagnosis are much less frequently met [5]. In the present study population, there was over-diagnosis in the screening and referral groups in 17.7% and 8.9%, respectively, with very young patients (mean ages 60 and 61 years).…”

Section: O V E R -D I a G N O S I S A N D U N D E R -D I A G N O S I mentioning

confidence: 57%

“…The overall mean (range) patient age was 60.9 (40-75) years, the mean PSA level 5.4 (1.2-10) ng/mL, the mean free/total PSA ratio 12.9 (2.7-58.4)%, the mean prostate volume (PV) 38.2 (12-130) mL and the mean GS 6.1 (4)(5)(6)(7)(8)(9)(10). The characteristics of the subgroups are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Pathological stages and GS were assessed; possible over-diagnosis was defined as a GS of < 7, a pathological stage of pT2a and negative surgical margins; under-diagnosis was defined as a pathological stage of ≥ pT3 or positive surgical margins [5]. Standard statistical tests were used, with P < 0.05 considered to indicate statistical significance.…”

Section: Methodsmentioning

confidence: 99%

“…In the present study, using the same definitions, under-diagnosis was 18.6% and 42.2% in the screened and referral group, respectively. In a recent study in our department, we evaluated patients in the low PSA group (2.0-3.9 ng/mL) that would not have been detected if the threshold PSA level for a prostate biopsy was > 4.0 ng/mL [5]. In this population the rates of over-diagnosis were at 19.7% and 16.5% in the low-PSA and higher PSA levels, respectively.…”

Section: O V E R -D I a G N O S I S A N D U N D E R -D I A G N O S I mentioning

confidence: 99%

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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

Pelzer¹,

Colleselli²,

Bektic³

et al. 2008

BJU International

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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.

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Early Detection and Screening for Prostate Cancer

Leeuwen¹,

Roobol²,

Schröder³

2010

Evidence‐Based Urology

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Under Diagnosis and Over Diagnosis of Prostate Cancer in a Screening Population With Serum PSA 2 to 10 ng/ml

Cited by 29 publications

References 18 publications

Upgrading of Gleason score 6 prostate cancers on biopsy after prostatectomy in the low and intermediate tPSA range

Upgrading of Gleason score 6 prostate cancers on biopsy after prostatectomy in the low and intermediate tPSA range

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

Early Detection and Screening for Prostate Cancer

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