PURPOSE: We quantified the rates of over and under diagnosis of prostate cancer in 2 large patient cohorts during the last 15 years. MATERIALS AND METHODS: A total of 2,126 men with clinical stage T1c prostate cancer were treated with radical prostatectomy during 1 of the 3 periods 1989 to 1995, 1995 to 2001 and 2001 to 2005. The respective proportions of men with a tumor that met our criteria for over diagnosis (0.5 cm3 or less, confined to the prostate with clear surgical margins and no Gleason pattern 4 or 5) and under diagnosis (nonorgan confined, pathological stage T3 or greater, or positive surgical margins) were examined. RESULTS: The proportion of men with an over diagnosed tumor was 1.3% to 7.1%. The proportion with prostate cancer that was under diagnosed was 25% to 30%. An ancillary finding was that decreasing the prostate specific antigen threshold for biopsy from 4.0 to 2.5 ng/ml in the screened population resulted in a lower rate of under diagnosis from 30% to 26%, a higher rate of over diagnosis from 1.3% to 7.1% and an increase in the 5-year progression-free survival rate from 85% to 92%. Men who were 55 years or younger were significantly more likely to meet our criteria for over diagnosed cancer. CONCLUSIONS: Under diagnosis of prostate cancer continues to occur more frequently than over diagnosis. Lowering the prostate specific antigen threshold for recommending biopsy to 2.5 ng/ml resulted in a lower rate of under diagnosis and a higher progression-free survival rate.
PURPOSE: We quantified the rates of over and under diagnosis of prostate cancer in 2 large patient cohorts during the last 15 years. MATERIALS AND METHODS: A total of 2,126 men with clinical stage T1c prostate cancer were treated with radical prostatectomy during 1 of the 3 periods 1989 to 1995, 1995 to 2001 and 2001 to 2005. The respective proportions of men with a tumor that met our criteria for over diagnosis (0.5 cm3 or less, confined to the prostate with clear surgical margins and no Gleason pattern 4 or 5) and under diagnosis (nonorgan confined, pathological stage T3 or greater, or positive surgical margins) were examined. RESULTS: The proportion of men with an over diagnosed tumor was 1.3% to 7.1%. The proportion with prostate cancer that was under diagnosed was 25% to 30%. An ancillary finding was that decreasing the prostate specific antigen threshold for biopsy from 4.0 to 2.5 ng/ml in the screened population resulted in a lower rate of under diagnosis from 30% to 26%, a higher rate of over diagnosis from 1.3% to 7.1% and an increase in the 5-year progression-free survival rate from 85% to 92%. Men who were 55 years or younger were significantly more likely to meet our criteria for over diagnosed cancer. CONCLUSIONS: Under diagnosis of prostate cancer continues to occur more frequently than over diagnosis. Lowering the prostate specific antigen threshold for recommending biopsy to 2.5 ng/ml resulted in a lower rate of under diagnosis and a higher progression-free survival rate.
Authors: Matthew D Greer; Nathan Lay; Joanna H Shih; Tristan Barrett; Leonardo Kayat Bittencourt; Samuel Borofsky; Ismail Kabakus; Yan Mee Law; Jamie Marko; Haytham Shebel; Francesca V Mertan; Maria J Merino; Bradford J Wood; Peter A Pinto; Ronald M Summers; Peter L Choyke; Baris Turkbey Journal: Eur Radiol Date: 2018-04-12 Impact factor: 5.315
Authors: Stacy Loeb; Marc A Bjurlin; Joseph Nicholson; Teuvo L Tammela; David F Penson; H Ballentine Carter; Peter Carroll; Ruth Etzioni Journal: Eur Urol Date: 2014-01-09 Impact factor: 20.096
Authors: Yohan Sumathipala; Nathan Lay; Baris Turkbey; Clayton Smith; Peter L Choyke; Ronald M Summers Journal: J Med Imaging (Bellingham) Date: 2018-12-15
Authors: M Graefen; S Ahyai; R Heuer; G Salomon; T Schlomm; H Isbarn; L Budäus; H Heinzer; H Huland Journal: Urologe A Date: 2008-03 Impact factor: 0.639
Authors: Jeong S Han; Adam D Toll; Ali Amin; H Ballentine Carter; Patricia Landis; Stephen Lee; Jonathan I Epstein Journal: Urology Date: 2012-08-22 Impact factor: 2.649