The high prevalence of undiagnosed prostate cancer at autopsy: implications for epidemiology and treatment of prostate cancer in the Prostate‐specific Antigen‐era

Widespread prostate‐specific antigen (PSA) screening detects many cancers that would have otherwise gone undiagnosed. To estimate the prevalence of unsuspected prostate cancer, we reviewed 19 studies of prostate cancer discovered at autopsy among 6,024 men. Among men aged 70–79, tumor was found in 3...

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Published in:International journal of cancer Vol. 137; no. 12; pp. 2795 - 2802
Main Authors: Jahn, Jaquelyn L., Giovannucci, Edward L., Stampfer, Meir J.
Format: Journal Article
Language:English
Published: United States Wiley Subscription Services, Inc 15.12.2015
Subjects:
Antigens
Asymptomatic Diseases - epidemiology
Autopsy
Cancer
Early Detection of Cancer
epidemiology
Humans
lethal prostate cancer
Male
Mass Screening
Medical research
Prevalence
Prostate cancer
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood
Prostatic Neoplasms - epidemiology
Prostatic Neoplasms - therapy
PSA‐screening
epidemiology
prostate cancer
autopsy
PSA-screening
lethal prostate cancer
ISSN:0020-7136, 1097-0215, 1097-0215
Online Access:Get full text
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Summary:Widespread prostate‐specific antigen (PSA) screening detects many cancers that would have otherwise gone undiagnosed. To estimate the prevalence of unsuspected prostate cancer, we reviewed 19 studies of prostate cancer discovered at autopsy among 6,024 men. Among men aged 70–79, tumor was found in 36% of Caucasians and 51% of African‐Americans. This enormous prevalence, coupled with the high sensitivity of PSA screening, has led to the marked increase in the apparent incidence of prostate cancer. The impact of PSA screening on clinical practice is well‐recognized, but its effect on epidemiologic research is less appreciated. Before screening, a larger proportion of incident prostate cancers had lethal potential and were diagnosed at advanced stage. However, in the PSA era, overall incident prostate cancer mainly is indolent disease, and often reflects the propensity to be screened and biopsied. Studies must therefore focus on cancers with lethal potential, and include long follow‐up to accommodate the lead time induced by screening. Moreover, risk factor patterns differ markedly for potentially lethal and indolent disease, suggesting separate etiologies and distinct disease entities. Studies of total incident or indolent prostate cancer are of limited clinical utility, and the main focus of research should be on prostate cancers of lethal potential.
Bibliography:Potential conflicts of interest: The authors have no conflicts of interest to disclose.
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ISSN:0020-7136
1097-0215
1097-0215
DOI:10.1002/ijc.29408