Overdiagnosis Due to Prostate-Specific Antigen Screening: Lessons From U.S. Prostate Cancer Incidence Trends

Etzioni R, Penson DF, Legler JM, et al. J Natl Cancer Inst. 2002; 94:981-990.

Abstr Hematol Oncol. 2002;5(4) 

In This Article


A potential drawback of prostate-specific antigen (PSA) testing is overdiagnosis of clinically insignificant prostate cancer. In the absence of quantitative estimates, the magnitude of this problem is unknown. To shed light on the issue, estimated rates of prostate cancer overdiagnosis associated with PSA testing were compared with data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry on observed incidence of prostate cancer in the United States from 1988 to 1998. Overdiagnosis was defined as the detection of prostate cancer through testing that would not otherwise have been identified during the patient's lifetime.

Estimated rates were figured using a computer simulation model of PSA testing that developed rates of occurrence of diagnosis and death from prostate cancer among a hypothetical cohort of 2 million men who would have been 60 to 84 years old in 1988. By comparing the model-projected incidence with the observed incidence derived from SEER registry data, lead times and corresponding overdiagnosis rates consistent with the observed SEER data were determined.

The data suggested that between 1988 and 1998 the rate of overdiagnosis of prostate cancer associated with PSA testing was approximately 29% among white men and 44% among black men. The rate of overdiagnosis among men with prostate cancer that would have been detected only at autopsy was, at most, 15% among white men and 37% among black men. The findings suggest that overdiagnosis associated with PSA testing is considerable but that the majority of screen-detected cancers diagnosed between 1988 and l998 would have presented clinically.


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