Over- and Underdiagnosis of Prostate Cancer: The Dangers

Abstract

Objectives To give an overview on the risks of over- and underdiagnosis of prostate cancer (PCa) using the current diagnosis policy. Methods The authors report on the results obtained by some important European and American screening and prevention programs: the Tyrol Screening Project, the Prostate Cancer Prevention Trial (PCPT), the European Randomized Study of Screening for Prostate Cancer (ERSSPC). An update is made on the new markers helping to improve the specificity of PCa diagnosis. Results Lowering the PSA threshold has dramatically increased the number of patients getting a biopsy. In the Tyrol Screening Project, 76% of the patients diagnosed with PCa were Gleason score <6. In a subanalysis of the PCPT, 77.7% of the patients at the “end-of-study” biopsy had score of 5 or 6. In the ERSSPC, 6% of the patients had a biopsy Gleason score <7. New emerging markers will help to overcome the PSA limitations: PCA3 (DD3) for instance, the most PCa-specific gene, is found to be over-expressed in more than 95% of PCa specimens and is suitable for the development of molecular urine analysis for PCa diagnosis. Conclusions The widespread use of PSA has led to a dramatic increase in the number of patients diagnosed with PCa, a significant number of them being non clinically significant. Hopefully, integration of gene expression signatures and clinical variables will help in the near future to produce much better predictive models.