Under Diagnosis and Over Diagnosis of Prostate Cancer

Graif, Theresa; Loeb, Stacy; Roehl, Kimberly A.; Gashti, Sara N.; Griffin, Christopher; Yu, Xiaoying; Catàlona, William J.

doi:10.1016/j.juro.2007.03.017

Cited by 69 publications

(42 citation statements)

References 14 publications

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“…Men over 70, particularly with comorbidity, who have a psa greater than 10 ng/mL or minor elements of a Gleason 4 pattern may still be appropriate candidates. Conversely, men under 70 with substantial Gleason 4 pattern (or any Gleason 4 pattern, some would argue 26 ) are not good candidates for surveillance. The evidence suggests that their likelihood of disease progression is about 3 times that of patients without a Gleason 4 pattern.…”

Section: Who Is a Candidate?mentioning

confidence: 99%

Active Surveillance for Prostate Cancer: Patient Selection and Management

Klotz

2010

Current Oncology

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Screening for prostate cancer using prostate-specific antigen (psa) has been appealing. However, the significant associated decline in prostate cancer mortality comes at the cost of a very high rate of diagnosis, and many patients with indolent, non-life-threatening cancer are exposed to the risk of significant side effects from radical treatment. Most men with favourablerisk prostate cancer are not destined to die of their disease, even in the absence of treatment. The challenge is to identify the subset that harbour more aggressive disease early enough that curative therapy is still a possibility, thereby allowing the others to enjoy improved quality of life, free from the side effects of treatment. This article reviews current research into active surveillance in favourable-risk disease and some of the issues that arise when prostate cancer is monitored rather than being treated immediately.

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Section: Who Is a Candidate?mentioning

confidence: 99%

Active Surveillance for Prostate Cancer: Patient Selection and Management

Klotz

2010

Current Oncology

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“…In a recent study Catalona et al [12] quantified the rates of over-and under-diagnosis of cancer after RP in two large cohorts. Under-diagnosis was defined as extraprostatic tumour of ≥ pT3, or positive surgical margins.…”

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%

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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“…It is currently the most commonly diagnosed malignancy and the second leading cause of cancer death, representing nearly 29% of all male cancer deaths (Li et al 2006, Karan et al 2003, Peehl 2005, Berger et al 2004, Rose et al 2005, Dhanasekaran et al 2001, Lapointe et al 2004, Luo et al 2001, Singh et al 2002,Varambally et al 2002, Welsh et al 2001, Rhodes et al 2002, Tanguay 2000, Yu et al 2004, Tomlins et al 2007, LaTulippe et al 2002, Mhawech-Fauceglia et al 2007, Hessels et al 2010, Graif et al 2007, Esserman et al 2009). he current methods for detecting prostate cancer include the prostate-speciic antigen (PSA) blood test, a digital rectal examination (DRE), transrectal ultrasound (TRUS) and biopsy.…”

Section: Introductionmentioning

confidence: 99%

“…However each of these tests suffers from signiicant limitations in sensitivity and speciicity. New biomarkers are needed for prostate cancer diagnosis and treatment planning (Li et al 2006, Graif et al 2007, Esserman et al 2009). Newly developed single gene biomarkers, such as initially highly promising prostate cancer antigen 3 (PCA3), are still under investigation.…”

Section: Introductionmentioning

confidence: 99%

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Multi-gene biomarker panel for reference free prostate cancer diagnosis: determination and independent validation

Čuperlović-Culf¹,

Belacel²,

Davey³

et al. 2010

Biomarkers

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Identification of biomarkers that can accurately and reliably diagnose prostate cancer is clinically highly desirable. A novel classification method, K-closest resemblance was applied to several high-quality transcriptomic datasets of prostate cancer leading to the discovery of a panel of eight gene biomarkers that can detect prostate cancer with over 96% specificity and sensitivity in leave-one-out cross-validation. Independent validation on clinical samples confirmed the discriminatory power of this gene panel, yielding over 95% accuracy of diagnosis based on receiver-operating characteristic curve analyses. Different levels of validation of the proposed biomarker panel have shown that it allows extremely accurate diagnosis of prostate cancer. Application of this panel can possibly add a fast and objective tool to the pathologist's arsenal following further clinical testing.

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Under Diagnosis and Over Diagnosis of Prostate Cancer

Abstract: Under diagnosis of prostate cancer continues to occur more frequently than over diagnosis. Lowering the prostate specific antigen threshold for recommending biopsy to 2.5 ng/ml resulted in a lower rate of under diagnosis and a higher progression-free survival rate.

Cited by 69 publications

References 14 publications

Active Surveillance for Prostate Cancer: Patient Selection and Management

Active Surveillance for Prostate Cancer: Patient Selection and Management

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

Multi-gene biomarker panel for reference free prostate cancer diagnosis: determination and independent validation

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