Prostate Cancer Overdiagnosis Risk Increases Substantially In Older Men

Researchers astatine Queen Mary University of London person recovered that nan likelihood of prostate crab overdiagnosis – nan discovery of a crab that would ne'er person been diagnosed during a patient's life but for PSA screening – is debased successful younger men but rises substantially pinch aged age.

In a caller study, published connected 21 April successful the International Journal of Cancer, researchers from Queen Mary University of London recovered that overdiagnosis of prostate crab done prostate-specific antigen (PSA) screening is debased successful younger men, but it rises sharply pinch age. 

The study, which aimed to estimate nan effect of property connected overdiagnosis of prostate crab 15 years aft screening stops, analysed semipermanent follow-up information from nan UK CAP (Cluster Randomised Trial of PSA Testing for Prostate cancer) trial, alongside English antheral mortality rates.

Analyzing information from much than 400,000 men randomised arsenic portion of nan CAP trial, nan squad compared nan prostate crab discovery complaint astatine screening (1.17%) pinch nan quality successful incidence 15 years post-screening (0.14%). They recovered that 11.7% of prostate cancers diagnosed astatine nan one-off PSA surface would person remained undiagnosed for 15 years if they had been randomised to nan power limb (not invited for screening), and importantly, if they would not dice from different causes. 

However, erstwhile competing mortality (ie, nan consequence of dying from thing different than prostate cancer) was factored in, nan squad recovered that nan image changed markedly by age:

• Men diagnosed astatine property 50 had a 16% chance that their crab would ne'er person been detected wrong 15 years 
• This roseate to 32% for men diagnosed aged 70

And roseate further to 58% for men diagnosed astatine property 80.

The findings propose that prostate crab screening and PSA testing is much due for men successful their 50s and early 60s, arsenic location are apt to beryllium debased levels of overdiagnosis successful this group.

These findings propose nan request for much targeted, age-informed PSA testing aliases prostate crab screening policies, including reexamining PSA testing policies successful settings wherever they person led to precocious rates of opportunistic screening successful older men, for illustration nan UK.

This is because nan existent `PSA tests connected demand' healthcare argumentation has led to precocious rates of opportunistic PSA testing successful older men, who are astatine precocious consequence of harms from overdiagnosis. These harms see unnecessary curen – including room and radiotherapy – which carries important broadside effects and tin person a antagonistic effect connected nan value of life of men whose cancers would ne'er person harmed them. In addition, screening men older than 70 years is besides improbable to confer use successful position of mortality reduction." 

Dr Adam Brentnall, Reader successful Biostatistics astatine Queen Mary's Wolfson Institute of Population Health and lead writer of nan study

The authors statement that location are immoderate limitations to their analysis, including nan truth that screening successful nan CAP proceedings was done earlier nan usage of magnetic resonance imaging targeted biopsy, which is expected to trim overdiagnosis. Ongoing trials, including TRANSFORM, co-led by Professor Rhian Gabe from Queen Mary and IMProVE co-led by Queen Mary's Professor Peter Sasieni successful nan UK, will thief to supply further grounds connected overdiagnosis utilizing modern screening protocols.