Prostate cancer screening: the problem of overdiagnosis and lessons to be learned from breast cancer screening

“…Meanwhile, it is difficult for PSA screening to distinguish the early stages of CaP from BPH effectively, especially when the PSA levels are within the 2-10 ng/ml range [9]. In addition, PSA screening may result in the overdiagnosis and over-treatment of indolent CaP patients [10,11]. Apart from the unbearable physiological and psychological inconvenience caused by PSA screening, the increased financial costs for health care systems globally should be taken into account as well.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of microRNAs expression in prostate cancer

2014

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MicroRNAs (miRNAs) have been proposed as ideal diagnostic indicators of prostate cancer (CaP). However, previous studies have reported conflicting results. Therefore, we conducted this meta-analysis to assess the potential diagnostic value of miRNAs for CaP. A systematic literature search was conducted in PubMed and other databases. Results from different studies were pooled using random effects models. The pooled sensitivity (SEN), specificity (SPE), positive and negative likelihood ratios (PLR and NLR, respectively), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated to evaluate the overall test performance. Between-study heterogeneity was tested using the chi-squared test and the I (2) test. Meta-regression and subgroup analyses were performed to explore the potential sources of heterogeneity. Fifty-eight studies from ten articles, including 669 patients with CaP and 404 controls composed of healthy individuals and patients with benign prostatic hyperplasia (BPH), were included in this meta-analysis. The pooled SEN and SPE were 0.74 (95 % confidence interval (CI) 0.70-0.78) and 0.73 (95 % CI 0.70-0.76), respectively. The pooled PLR was 2.7 (95 % CI 2.4-3.1); NLR was 0.35 (95 % CI 0.30-0.42); and DOR was 8 (95 % CI 6-10). The pooled AUC was 0.79 (95 % CI 0.76-0.83). Subgroup analyses indicated that multiple miRNAs yielded a better diagnostic accuracy. This systematic review suggests that miRNA analysis can significantly improve the overall accuracy of CaP diagnosis. Moreover, using multiple miRNA-based assays could achieve significantly higher accuracy in diagnosing CaP than single miRNA-based assays.

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“…On the contrary there is much evidence that screening causes over‐diagnosis and over‐treatment of slow‐growing indolent cancer and because of the limited life‐expectancy of screened subjects, and the high prevalence of latent cancer [4], this seems a major negative aspect of screening. Estimates of over‐diagnosis are 29–44%[5] and 50–300%[6], values that might outweigh the benefits of screening.…”

Section: Introductionmentioning

confidence: 99%

Contamination by opportunistic screening in the European Randomized Study of Prostate Cancer Screening

et al. 2003

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Prostate cancer screening: the problem of overdiagnosis and lessons to be learned from breast cancer screening

Cited by 38 publications

References 6 publications

Occupational risk factors for prostate cancer and benign prostatic hyperplasia: a case–control study in Western Australia

Occupational risk factors for prostate cancer and benign prostatic hyperplasia: a case–control study in Western Australia

Diagnostic performance of microRNAs expression in prostate cancer

Contamination by opportunistic screening in the European Randomized Study of Prostate Cancer Screening

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