{"entity":{"id":"paper-loeb-overdiagnosis-overtreatment-prostate-eur-urol-2014","kind":"paper","name":"Overdiagnosis and overtreatment of prostate cancer","aka":["Loeb 2014 overdiagnosis review","prostate overdiagnosis 1.7 to 67 percent"],"tldr":"A review that gathered every way overdiagnosis in prostate cancer has been measured and found estimates from under two percent to two thirds, depending entirely on the method. The one figure everyone can agree on is that autopsy studies find prostate cancer in around a fifth to two fifths of men who died of something else.","summary":"Stacy Loeb, Ruth Etzioni and colleagues reviewed the primary data on prostate cancer overdiagnosis and overtreatment from epidemiological, clinical and autopsy studies. Overdiagnosis has been estimated by lead-time modelling, by excess incidence, by the frequency of low-grade minimal tumours in prostatectomy specimens and by finding cancer in men who died of other causes, and each method gives a different answer.\n\nThe review is the right citation for the open problem rather than any single number, because it demonstrates that the number is not a property of the disease but of the study design and the background incidence. It also records the direction of travel on the treatment side: contemporary international studies show increasing use of conservative management, which is the only lever that turns overdiagnosis from a harm into a statistic.","asOf":"2026-09-25","links":[{"label":"Eur Urol 2014","url":"https://doi.org/10.1016/j.eururo.2013.12.062"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/24439788/"}],"tags":["prostate-evidence"],"related":["paper-draisma-lead-time-overdiagnosis-psa-jnci-2009","paper-welch-albertsen-psa-era-diagnosis-treatment-jnci-2009","paper-klotz-active-surveillance-jco-2015","idea-prev-gleason6-terminology-rct","prostate-roadmap"],"cancers":["prostate","prostate-low-risk"],"sections":["early-detection","prevention"],"technologies":["active-surveillance"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["overdiagnosis","screening","psa","gleason-grade-group","overtreatment","lead-time-bias"],"trials":[],"people":[],"bottlenecks":["b-overdiagnosis","b-early-detection","b-toxicity-qol","b-patient-voice"],"keyPapers":[],"journals":["european-urology"],"dependsOn":[],"notes":[],"journal":"European Urology","year":2014,"doi":"10.1016/j.eururo.2013.12.062","pmid":"24439788","authors":"Loeb S, Bjurlin MA, Nicholson J, et al.","paperType":"review","findings":["Estimates of overdiagnosis across epidemiological, clinical and autopsy studies ranged from 1.7 percent to 67 percent.","The estimated number of prostate cancers needing to be diagnosed to save one life ranged from 48 down to 5 with increasing follow-up.","In clinical studies based on the frequency of low-grade minimal tumours at radical prostatectomy, reported overdiagnosis rates were 1.7 to 46.8 percent.","Autopsy studies reported prostate cancer in 18.5 to 38.5 percent of men, although not all of it was low grade or low volume.","Reported rates of overtreatment vary widely and contemporary international studies suggest increasing use of conservative management."],"whatItMeans":"The honest state of the overdiagnosis question. Prostate cancer is common in the prostates of men who die of something else, screening finds a proportion of it, and how much of that is harm depends on what is done next. The fix is not a better estimate but fewer treatments for the cancers that do not need them.","caveats":["A narrative review with a systematic search rather than a pooled quantitative analysis, so it summarises heterogeneity rather than resolving it.","Autopsy prevalence is not the same as overdiagnosis: some autopsy-detected cancer is high grade and would have surfaced.","Published in 2014, before magnetic resonance imaging triage and before active surveillance reached its current share of low-risk management, so the overtreatment figures are historical."],"changedPractice":false},"route":"/key-papers/paper-loeb-overdiagnosis-overtreatment-prostate-eur-urol-2014/","neighbours":{"paper":[{"id":"paper-draisma-lead-time-overdiagnosis-psa-jnci-2009","kind":"paper","name":"Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context","route":"/key-papers/paper-draisma-lead-time-overdiagnosis-psa-jnci-2009/"},{"id":"paper-klotz-active-surveillance-jco-2015","kind":"paper","name":"Long-term follow-up of a large active surveillance cohort of patients with prostate cancer (Sunnybrook)","route":"/key-papers/paper-klotz-active-surveillance-jco-2015/"},{"id":"paper-welch-albertsen-psa-era-diagnosis-treatment-jnci-2009","kind":"paper","name":"Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening, 1986 to 2005","route":"/key-papers/paper-welch-albertsen-psa-era-diagnosis-treatment-jnci-2009/"},{"id":"paper-uspstf-prostate-screening-jama-2018","kind":"paper","name":"USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over)","route":"/key-papers/paper-uspstf-prostate-screening-jama-2018/"}],"idea":[{"id":"idea-prostate-metastatic-presentation-as-the-screening-endpoint","kind":"idea","name":"Judge a prostate screening programme on metastatic presentation, not on incidence or mortality","route":"/ideas/idea-prostate-metastatic-presentation-as-the-screening-endpoint/"},{"id":"idea-prev-gleason6-terminology-rct","kind":"idea","name":"Test whether calling Gleason 6 'not cancer' changes what men choose","route":"/ideas/idea-prev-gleason6-terminology-rct/"}],"roadmap":[{"id":"prostate-roadmap","kind":"roadmap","name":"Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch","route":"/roadmaps/prostate-roadmap/"}],"cancer":[{"id":"prostate-low-risk","kind":"cancer","name":"Localised prostate cancer, very low and low risk","route":"/cancers/prostate-low-risk/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"},{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"}],"technology":[{"id":"active-surveillance","kind":"technology","name":"Active surveillance","route":"/technologies/active-surveillance/"}],"term":[{"id":"gleason-grade-group","kind":"term","name":"Gleason score / Grade Group","route":"/terms/gleason-grade-group/"},{"id":"lead-time-bias","kind":"term","name":"Lead time, and lead-time bias","route":"/terms/lead-time-bias/"},{"id":"overdiagnosis","kind":"term","name":"Overdiagnosis","route":"/terms/overdiagnosis/"},{"id":"overtreatment","kind":"term","name":"Overtreatment","route":"/terms/overtreatment/"},{"id":"psa","kind":"term","name":"PSA (prostate-specific antigen)","route":"/terms/psa/"},{"id":"screening","kind":"term","name":"Screening","route":"/terms/screening/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"},{"id":"b-patient-voice","kind":"bottleneck","name":"Patients lack understanding, navigation and agency","route":"/bottlenecks/b-patient-voice/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"journal":[{"id":"european-urology","kind":"journal","name":"European Urology","route":"/journals/european-urology/"}]}}