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Estimates of how many screen-detected prostate cancers would never have caused trouble ranged from a quarter to more than four fifths. Three independent models were run side by side to find out why, and showed the answer depends almost entirely on how the question is asked.
Gerrit Draisma, Ruth Etzioni and colleagues ran three independently developed models of prostate cancer progression and detection, all calibrated to Surveillance, Epidemiology, and End Results incidence, to estimate lead time and overdiagnosis among United States men aged 54 to 80 between 1985 and 2000. They also compared the United States estimates against earlier ones from the Rotterdam section of the European screening trial.
The finding is a methodological one with a very practical consequence. The three models agreed closely with each other for any given definition of lead time, and disagreed substantially across definitions: mean lead time ranged from 5.4 to 6.9 years and overdiagnosis from 23 to 42 percent of screen-detected cancers in the United States calibration, while the Rotterdam calibration of the same model family gave 7.9 years and 66 percent. Quoting a single overdiagnosis percentage for prostate screening without saying which definition and which population it came from is therefore not meaningful.
The reference for anyone quoting an overdiagnosis figure in prostate cancer. The honest statement is a range with its definition and its population attached, and the paper is the reason this page does not print one number.
One technology page on OnCo cites this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing page listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
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.
The evidence that prostate-specific antigen screening works, stated together with the price. It is the reason screening programmes are debated rather than simply adopted, and the reason every subsequent proposal, from magnetic resonance imaging first to risk-model invitation, is judged on whether it keeps the mortality benefit while reducing the 48.
The number that anchors the overdiagnosis argument in prostate cancer: over a million American men treated for a cancer that, for most of them, was never going to surface. It is the reason active surveillance exists as a formal pathway and the reason magnetic resonance imaging was brought in front of the biopsy.
Shares Lead time, and lead-time bias, ERSPC: screening and prostate cancer mortality in a randomised European study, Overtreatment, Overdiagnosis and the tag prostate-evidence.
Shares Lead time, and lead-time bias, Number needed to screen (and number needed to diagnose), ERSPC: screening and prostate cancer mortality in a randomised European study, PSA (prostate-specific antigen) and the tag prostate-evidence.
Shares Overdiagnosis and overtreatment of prostate cancer, Number needed to screen (and number needed to diagnose), Overtreatment, Judge a prostate screening programme on metastatic presentation, not on incidence or mortality and the tag prostate-evidence.
Shares Lead time, and lead-time bias, Number needed to screen (and number needed to diagnose), ERSPC: screening and prostate cancer mortality in a randomised European study, PSA (prostate-specific antigen) and the tag prostate-evidence.
Shares Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening, 1986 to 2005, PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk, Overdiagnosis and false alarms and the tag prostate-evidence.
Shares Overtreatment, Overdiagnosis, PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk and the tag prostate-evidence.
Shares PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk, Screening, Overdiagnosis and false alarms and the tag prostate-evidence.
Shares PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk, 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, Biomarkers are not validated or standardised and the tag prostate-evidence.