Overdiagnosis and overtreatment of early detected prostate cancer

Bangma, Chris H.; Roemeling, Stijn; Schröder, Fritz H.

doi:10.1007/s00345-007-0145-z

Cited by 142 publications

(73 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Overdiagnosis also occurs when screening detects a lung cancer that satisfies histologic criteria of malignancy, but that is so biologically indolent that it will never contribute to death. This concept is well established as a consideration in prostate carcinoma screening (36)(37)(38), but has been relatively ignored in lung cancer because of the high lethality of most symptom-detected cancers.…”

Section: Survival Versus Mortality Endpoints In Screeningmentioning

confidence: 99%

Lung Cancer Screening with CT

Aberle

Brown

2008

Clinics in Chest Medicine

View full text Add to dashboard Cite

Lung cancer is the leading cause of cancer death in the United States. In 2007, it is estimated that 160,390 lung cancer deaths will occur in the US, representing 29% of all cancer deaths (1). Roughly 87% of lung cancers are attributed to cigarette smoking (2). Although cancer risk is attenuated by smoking cessation, the risk is not eliminated, and lung cancer now occurs with equal frequency in current and former smokers (3). Moreover, other factors clearly influence risk, including age; family history; chronic obstructive pulmonary disease; pulmonary fibrosis; and exposures to environmental radon, asbestos, and certain other occupational agents (4). Realistically, lung cancer will likely remain at epidemic proportions for decades to come.Non-small cell lung cancer (NSCLC), which accounts for 75-80% of all lung cancers, is typically diagnosed when disease is locally advanced or there are systemic metastases (5), explaining the dismal overall five-year survival of 15% (6). In contrast, the five-year survival of individuals with surgically resected, early stage NSCLC approaches 75% (6,7). These differences have fueled the impetus to find a screening test that can detect NSCLC in its early preclinical stages, when surgical resection is most likely to prolong life and potentially reduce lung cancer mortality. Although earlier randomized controlled trials of lung cancer screening using chest radiography and sputum cytology failed to show reduced lung cancer mortality, computed tomography (CT) is a much more sensitive test for detecting small lung nodules, and has generated considerable enthusiasm as a potential contemporary screening tool for lung cancer.

show abstract

Section: Survival Versus Mortality Endpoints In Screeningmentioning

confidence: 99%

Lung Cancer Screening with CT

Aberle

Brown

2008

Clinics in Chest Medicine

View full text Add to dashboard Cite

show abstract

“…Currently, the US Preventive Task Force, the American Academy of Family Physicians, the American College of Physicians, the National Cancer Institute, and the EGTM do not recommend population-based prostate cancer screening (177,178 ). The overriding concern is that current screening modalities result in overdiagnosis and overtreatment of early stage disease that may not be clinically significant, as has recently been reviewed (179 ).…”

Section: Merits Of Early Detection Of Prostate Cancermentioning

confidence: 99%

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Testicular, Prostate, Colorectal, Breast, and Ovarian Cancers

et al. 2008

View full text Add to dashboard Cite

Background: Updated National Academy of Clinical Biochemistry (NACB) Laboratory Medicine Practice Guidelines for the use of tumor markers in the clinic have been developed. Methods: Published reports relevant to use of tumor markers for 5 cancer sites—testicular, prostate, colorectal, breast, and ovarian—were critically reviewed. Results: For testicular cancer, α-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase are recommended for diagnosis/case finding, staging, prognosis determination, recurrence detection, and therapy monitoring. α-Fetoprotein is also recommended for differential diagnosis of nonseminomatous and seminomatous germ cell tumors. Prostate-specific antigen (PSA) is not recommended for prostate cancer screening, but may be used for detecting disease recurrence and monitoring therapy. Free PSA measurement data are useful for distinguishing malignant from benign prostatic disease when total PSA is <10 μg/L. In colorectal cancer, carcinoembryonic antigen is recommended (with some caveats) for prognosis determination, postoperative surveillance, and therapy monitoring in advanced disease. Fecal occult blood testing may be used for screening asymptomatic adults 50 years or older. For breast cancer, estrogen and progesterone receptors are mandatory for predicting response to hormone therapy, human epidermal growth factor receptor-2 measurement is mandatory for predicting response to trastuzumab, and urokinase plasminogen activator/plasminogen activator inhibitor 1 may be used for determining prognosis in lymph node–negative patients. CA15-3/BR27–29 or carcinoembryonic antigen may be used for therapy monitoring in advanced disease. CA125 is recommended (with transvaginal ultrasound) for early detection of ovarian cancer in women at high risk for this disease. CA125 is also recommended for differential diagnosis of suspicious pelvic masses in postmenopausal women, as well as for detection of recurrence, monitoring of therapy, and determination of prognosis in women with ovarian cancer. Conclusions: Implementation of these recommendations should encourage optimal use of tumor markers.

show abstract

“…Subsequent to the introduction and adoption of prostate-specific antigen (PSA) testing, the incidence of prostate cancer increased rapidly from 1990 to a peak in 1993 and a second, less-pronounced peak in 2001 (Figure 1). Much of the excess incidence represents overdiagnosis, 4,5 that is, the detection of cancers that would not progress to cause symptoms or death. 6 There is no conclusive evidence to determine what proportion of the decline in prostate cancer mortality is due to screening versus improved treatment, or other factors; it is likely that both screening and treatment have contributed.…”

mentioning

confidence: 99%

Recommendations on screening for prostate cancer with the prostate-specific antigen test

Bell

Gorber

Shane

et al. 2014

CMAJ

166

136

View full text Add to dashboard Cite

• The prevalence of undiagnosed prostate cancer at autopsy is high and increases with age (> 40% among men aged 40-49 yr to > 70% among men aged 70-79 yr).• Only a small proportion of men with prostate cancer have symptoms or die from the disease; most prostate cancers are slowly progressive and not life threatening.• Screening with the PSA test may lead to a small reduction in prostate cancer mortality but not a reduction in all-cause mortality.• Thresholds for PSA of 2.5 to 4.0 ng/mL are commonly used for screening; lower thresholds increase the probability of false-positive results, and no threshold completely excludes prostate cancer.• Harms associated with PSA screening (e.g., bleeding, infection, urinary incontinence, a false-positive result and overdiagnosis) are common.• The PSA test should not be used for screening without a detailed discussion with the patient, ideally with the use of decision aids to facilitate comprehension.

show abstract

Overdiagnosis and overtreatment of early detected prostate cancer

Cited by 142 publications

References 45 publications

Lung Cancer Screening with CT

Lung Cancer Screening with CT

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Testicular, Prostate, Colorectal, Breast, and Ovarian Cancers

Recommendations on screening for prostate cancer with the prostate-specific antigen test

Contact Info

Product

Resources

About