Prostate cancer incidence trends reveal extent of screening-related overdiagnosis

July 02, 2002

A new look at the recent surge in prostate cancer incidence suggests that 29% of cases in white men and 44% of cases in black men that are detected by prostate-specific antigen (PSA) testing, may represent overdiagnosis, or the detection of cancers that otherwise would not have been detected within the patient's lifetime. These findings appear in the July 3 issue of the Journal of the National Cancer Institute.

"This information is of great importance because considerable morbidity can be associated with treatment for the disease," says Ruth Etzioni, Ph.D., of the Fred Hutchinson Cancer Research Center in Seattle, and her colleagues.

The U.S. Food and Drug Administration approved PSA testing in 1986 as a way to monitor prostate cancer progression. Use of the test for prostate cancer screening caught on and increased dramatically beginning in 1988, despite little evidence to support a benefit in prostate cancer mortality reduction.

Concurrently, prostate cancer incidence increased sharply and had more than doubled by 1992 before going back down. This apparent surge in incidence prompted concern over prostate cancer overdiagnosis.

To estimate the extent of prostate cancer overdiagnosis that would have resulted in the incidence patterns observed from 1988 through 1998, Etzioni and her colleagues compared cancer registry data on observed prostate cancer incidence with a computer-based projection of the increase in incidence of prostate cancer that would have been expected in the absence of PSA testing. The computer model was based on a hypothetical cohort of 2 million men between the ages of 60 and 84.

The authors found that among men who were 60 to 84 years old in 1988, the estimated rate of overdiagnosis as a result of PSA screening was approximately 29% for white men and 44% for black men. These rates were consistent with the observed prostate cancer incidence for this age group from 1988 to 1998.

In an accompanying editorial, Siu-Long Yao, M.D., of Merck Research Laboratories, and Grace Lu-Yao, Ph.D., of HealthStat in Princeton, N.J., say that overdiagnosis could be even higher than what was estimated in this study if stricter criteria were used. They add that assuming that PSA screening is effective, overdiagnosis might be acceptable if not for the fact that many men diagnosed with prostate cancer by PSA testing would be subject to unnecessary biopsies and a substantial risk of side effects from treatment, even though they would not benefit from the treatment.

They conclude that "the consequences of overdiagnosis for the individual patient may be formidable, and for those who choose to discuss the option of screening with their health care provider, the important possibility of overdiagnosis should not be underestimated or overlooked."
-end-
Contact: Kristen Woodward, Fred Hutchinson Cancer Research Center, (206) 667-5095; fax: (206) 667-7005, kwoodwar@fhcrc.org.

Editorial: Grace Lu-Yao, HealthStat, (609) 933 2059, gly@aya.yale.edu

Etzioni R, Penson D, Legler J, di Tommasao D, Boer R, Gann P, et al. Overdiagnosis due to prostate-specific antigen screening: lessons from U.S. prostate cancer incidence trends. J Natl Cancer Inst 2002;94:981-90.

Yao S, Lu-Yao G. Understanding and appreciating overdiagnosis in PSA era. J Natl Cancer Inst 2002;94:958-9.

Attribution to the Journal of the National Cancer Institute is requested in all news coverage.

Journal of the National Cancer Institute

Related Prostate Cancer Articles from Brightsurf:

Low risk of cancer spread on active surveillance for early prostate cancer
Men undergoing active surveillance for prostate cancer have very low rates - one percent or less - of cancer spread (metastases) or death from prostate cancer, according to a recent study published in the Journal of Urology®, an Official Journal of the American Urological Association (AUA).

ESMO 2020: Breast cancer drug set to transform prostate cancer treatment
A drug used to treat breast and ovarian cancer can extend the lives of some men with prostate cancer and should become a new standard treatment for the disease, concludes a major trial which is set to change clinical practice.

Major trial shows breast cancer drug can hit prostate cancer Achilles heel
A drug already licensed for the treatment of breast and ovarian cancers is more effective than targeted hormone therapy at keeping cancer in check in some men with advanced prostate cancer, a major clinical trial reports.

The Lancet: Prostate cancer study finds molecular imaging could transform management of patients with aggressive cancer
Results from a randomised controlled trial involving 300 prostate cancer patients find that a molecular imaging technique is more accurate than conventional medical imaging and recommends the scans be introduced into routine clinical practice.

Common genetic defect in prostate cancer inspires path to new anti-cancer drugs
Researchers found that, in prostate cancer, a mutation leading to the loss of one allele of a tumor suppressor gene known as PPP2R2A is enough to worsen a tumor caused by other mutations.

First prostate cancer therapy to target genes delays cancer progression
For the first time, prostate cancer has been treated based on the genetic makeup of the cancer, resulting in delayed disease progression, delayed time to pain progression, and potentially extending lives in patients with advanced, metastatic prostate cancer, reports a large phase 3 trial.

Men taking medications for enlarged prostate face delays in prostate cancer diagnosis
University of California San Diego School of Medicine researchers report that men treated with medications for benign prostatic hyperplasia (enlarged prostate) experienced a two-year delay in diagnosis of their prostate cancer and were twice as likely to have advanced disease upon diagnosis.

CNIO researchers confirm links between aggressive prostate cancer and hereditary breast cancer
The study has potential implications for families with members suffering from these types of tumours who are at an increased risk of developing cancer.

Distinguishing fatal prostate cancer from 'manageable' cancer now possible
Scientists at the University of York have found a way of distinguishing between fatal prostate cancer and manageable cancer, which could reduce unnecessary surgeries and radiotherapy.

Researchers find prostate cancer drug byproduct can fuel cancer cells
A genetic anomaly in certain men with prostate cancer may impact their response to common drugs used to treat the disease, according to new research at Cleveland Clinic.

Read More: Prostate Cancer News and Prostate Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.