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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.
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.
The 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.
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 current shape of the screening question in the United States, and the best short statement of the trade-off in numbers a man can weigh. The three-to-one ratio between metastatic cases prevented and deaths prevented is also the argument for using metastatic presentation, not mortality, to judge a screening programme sooner.
Active surveillance is the preferred management for low-risk prostate cancer, and this cohort's triggers for intervention shaped surveillance protocols worldwide.
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.
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, USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over), Overtreatment, Overdiagnosis and the tag prostate-evidence.
Shares Long-term follow-up of a large active surveillance cohort of patients with prostate cancer (Sunnybrook), Overtreatment, Overdiagnosis, PSA (prostate-specific antigen) and the tag prostate-evidence.
Shares Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context, Lead time, and lead-time bias, Judge a prostate screening programme on metastatic presentation, not on incidence or mortality, Overdiagnosis and the tag prostate-evidence.
Shares Lead time, and lead-time bias, PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk, Screening 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 Lead time, and lead-time bias, PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk, Screening and the tag prostate-evidence.
Shares Overtreatment, Overdiagnosis, Gleason score / Grade Group, Overdiagnosis and false alarms and the tag prostate-evidence.
Shares European Urology, Gleason score / Grade Group, PSA (prostate-specific antigen), Localised prostate cancer, very low and low risk and the tag prostate-evidence.