Prostate-Specific Antigen Test May Increase Overdiagnosis

Over a million more men have been diagnosed with prostate cancer since test was introduced

03 sept 2009-- Since the prostate-specific antigen (PSA) test was introduced, many men have been overdiagnosed with prostate cancer, according to a study published online Aug. 31 in the Journal of the National Cancer Institute.

H. Gilbert Welch, M.D., of Dartmouth Medical School in Hanover, N.H., and Peter C. Albertsen, M.D., of the University of Connecticut School of Medicine in Farmington, analyzed data on age-specific incidence and initial course of treatment for prostate cancer from 1986, the year before the PSA test was introduced, to 2005.

The researchers estimate that 1,305,600 additional men have been diagnosed with prostate cancer since 1986, of whom 1,004,800 underwent treatment for the disease. For every man who was presumed to benefit from PSA screening, more than 20 had to be diagnosed, the investigators note.

"Estimating the trade-off between a mortality benefit and an overdiagnosis is problematic when there is uncertainty about whether the benefit exists at all," the authors write. "Although no single formula can determine the correct course of action when facing this trade-off, it is important that we begin to explicitly communicate to men who are considering screening the relative magnitude of number of deaths averted to the number overdiagnosed and make clear the harms of overdiagnosis."

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