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

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• 作者：Andrew J Vickers (17)
  Daniel D Sjoberg (17)
  David Ulmert (16) (21)
  Emily Vertosick (17)
  Monique J Roobol (19)
  Ian Thompson (22) (23)
  Eveline AM Heijnsdijk (20)
  Harry De Koning (20)
  Coral Atoria-Swartz (17)
  Peter T Scardino (16)
  Hans Lilja (16) (18) (21)
  
• 关键词：Prostate cancer ; Early detection ; Overdiagnosis ; PSA ; Screening
• 刊名：BMC Medicine
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：12
• 期：1
• 全文大小：202 KB
• 作者单位：Andrew J Vickers (17)
  Daniel D Sjoberg (17)
  David Ulmert (16) (21)
  Emily Vertosick (17)
  Monique J Roobol (19)
  Ian Thompson (22) (23)
  Eveline AM Heijnsdijk (20)
  Harry De Koning (20)
  Coral Atoria-Swartz (17)
  Peter T Scardino (16)
  Hans Lilja (16) (18) (21)
  
  17. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
  16. Department of Surgery (Urology), Memorial Sloan-Kettering Cancer Center, New York, NY, USA
  21. Departments of Laboratory Medicine and Clinical Sciences in Malm?, Lund University, University Hospital UMAS, Malm?, Sweden
  19. Department of Urology, Erasmus University Medical Center, Rotterdam, Netherlands
  22. The Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
  23. Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
  20. Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
  18. Laboratory Medicine and Medicine (GU-Oncology), Memorial Sloan-Kettering Cancer Center, New York, NY, USA
  
• ISSN：1741-7015

文摘

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--,577 and n--,197) and a population-based cohort of Swedish men not subject to PSA-screening followed for 25?years (n--,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.