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

Authors: Vickers, A. J.; Sjoberg, D. D.; Ulmert, D.; Vertosick, E.; Roobol, M. J.; Thompson, I.; Heijnsdijk, E. A. M.; De Koning, H.; Atoria-Swartz, C.; Scardino, P. T.; Lilja, H.
Article Title: Empirical estimates of prostate cancer overdiagnosis by age and prostate-specific antigen
Abstract: 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. © 2014 Vickers et al.; licensee BioMed Central Ltd.
Keywords: prostate cancer; screening; psa; early detection; overdiagnosis
Journal Title: BMC Medicine
Volume: 12
Issue: 1
ISSN: 1741-7015
Publisher: Biomed Central Ltd  
Date Published: 2014-02-11
Start Page: 26
Language: English
DOI: 10.1186/1741-7015-12-26
PROVIDER: scopus
PMCID: PMC3922189
PUBMED: 24512643
Notes: Export Date: 3 March 2014 -- Source: Scopus
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MSK Authors
  1. Peter T Scardino
    622 Scardino
  2. Hans Gosta Lilja
    286 Lilja
  3. Andrew J Vickers
    569 Vickers
  4. Daniel D. Sjoberg
    141 Sjoberg
  5. Hans David Staffan Ulmert
    50 Ulmert
  6. Coral Lynn Atoria
    49 Atoria