the difficult balance between prevention and overdiagnosis


  • Testing for PSA, a protein that signals cancer cells, helps screen for prostate cancer
  • But this test often leads to overdiagnosis and unnecessary treatment
  • As it is used less, diagnoses of serious cancers and metastases would increase

Overzealous? If we had reduced the use of PSA testing in prostate cancer to avoid overdiagnosis and unnecessary treatment, would we have missed cases of higher-stage cancer with metastases? That question comes after the publication of a study in the Journal of the National Cancer Institute, conducted by scientists at the Weill Conell Medical Center, showing that, in parallel with efforts to minimize over-detection of cancer, the incidence of serious disease and Metastases at the time of diagnosis has increased.

The benefits of the PSA test do not outweigh the risks

One of the weaknesses of screening for prostate cancer with a PSA test – a protein that is overproduced in cancer cells – is that it leads to overdetection of indolent cancers that do not put patients at risk, but which make them anxious and sometimes invasive to diagnose suspend testing“, states Dr.

The study was conducted using data from 438,000 men with newly identified prostate cancer between 23010 and 2018. Researchers examined trends in prostate cancer incidence using several measures: a pathological score based on microscopic examination of prostate cells, PSA levels, the presence of metastases at the time of diagnosis, and taking into account other factors such as obesity rate.

Increased rates of metastasis at diagnosis

This analysis found a significant reduction in the incidence of the least risky prostate cancer from 52 to 26 cases per 100,000 men. In contrast, metastasis rates at the time of diagnosis increased from 3% to 5.2% over the same period, with the discontinuation of PSA testing appearing to be the main reason for these trends. “The fact that only 10% of radical prostatectomy cases result in low-grade cancer shows that even when this type of disease is diagnosed, it is much less likely to be treated.“, emphasizes Dr. whoa

The authors of this work suggest that health authorities “implement risk-stratified screening such as MRI or biomarkers, continue to minimize overdiagnosis and avoid biopsies in patients with low-risk cancer, while addressing trends related to the increase in high-grade and metastatic prostate cancer.”

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