Underdiagnosis Of Prostate Cancer Research Articles

MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis

BackgroundThe use of 12-core systematic prostate biopsy is associated with diagnostic inaccuracy that contributes to both overdiagnosis and underdiagnosis of prostate cancer. Biopsies performed with magnetic resonance imaging (MRI) targeting may reduce the misclassification of prostate cancer in men with MRI-visible lesions.MethodsMen with MRI-visible prostate lesions underwent both MRI-targeted and systematic biopsy. The primary outcome was cancer detection according to grade group (i.e., a clustering of Gleason grades). Grade group 1 refers to clinically insignificant disease; grade group 2 or higher, cancer with favorable intermediate risk or worse; and grade group 3 or higher, cancer with unfavorable intermediate risk or worse. Among the men who underwent subsequent radical prostatectomy, upgrading and downgrading of grade group from biopsy to whole-mount histopathological analysis of surgical specimens were recorded. Secondary outcomes were the detection of cancers of grade group 2 or higher and grade group 3 or higher, cancer detection stratified by previous biopsy status, and grade reclassification between biopsy and radical prostatectomy.ResultsA total of 2103 men underwent both biopsy methods; cancer was diagnosed in 1312 (62.4%) by a combination of the two methods (combined biopsy), and 404 (19.2%) underwent radical prostatectomy. Cancer detection rates on MRI-targeted biopsy were significantly lower than on systematic biopsy for grade group 1 cancers and significantly higher for grade groups 3 through 5 (P<0.01 for all comparisons). Combined biopsy led to cancer diagnoses in 208 more men (9.9%) than with either method alone and to upgrading to a higher grade group in 458 men (21.8%). However, if only MRI-target biopsies had been performed, 8.8% of clinically significant cancers (grade group ≥3) would have been misclassified. Among the 404 men who underwent subsequent radical prostatectomy, combined biopsy was associated with the fewest upgrades to grade group 3 or higher on histopathological analysis of surgical specimens (3.5%), as compared with MRI-targeted biopsy (8.7%) and systematic biopsy (16.8%).ConclusionsAmong patients with MRI-visible lesions, combined biopsy led to more detection of all prostate cancers. However, MRI-targeted biopsy alone underestimated the histologic grade of some tumors. After radical prostatectomy, upgrades to grade group 3 or higher on histopathological analysis were substantially lower after combined biopsy. (Funded by the National Institutes of Health and others; Trio Study ClinicalTrials.gov number, NCT00102544.)

Prostate ultrasound: back in business!

The use of grey scale prostate ultrasound decreased after the implementation of magnetic resonance imaging (MRI) for thediagnosis and evaluation of prostate cancer. The new developments, such as multiparametric ultrasound and MRI-ultrasoundfusion technology, renewed the interest for this imaging method in the assessment of prostate cancer. The purpose of this paperwas to review the current role of prostate ultrasound in the setting of these new applications. A thorough reevaluation of theselection criteria of the patients is required to assess which patients would benefit from multiparametric ultrasound, who wouldbenefit from multiparametric MRI or the combination of both to assist prostate biopsy in order to ensure the balance betweenoverdiagnosis and underdiagnosis of prostate cancer.

Doctors’ approaches to PSA testing and overdiagnosis in primary healthcare: a qualitative study

Objectives(1) To explain general practitioners’ (GPs’) approaches to prostate-specific antigen (PSA) testing and overdiagnosis; (2) to explain how GPs reason about their PSA testing routines and (3) to explain how...

Over‐diagnosis and under‐diagnosis of screen‐ vs non‐screen‐detected prostate cancers with in men with prostate‐specific antigen levels of 2.0–10.0 ng/mL

To evaluate possible over- and under-diagnosis of prostate cancer in a screened vs a referral population in the same range of prostate-specific antigen (PSA). In all, 1445 patients undergoing radical prostatectomy and with a PSA level of <10 ng/mL were evaluated; 237 were from outside Tyrol (Austria) and represented the unscreened group, and 1208 were Tyrolean screening volunteers. Over-diagnosis was defined as a pathological stage of pT2a and a Gleason score of <7 with no positive surgical margins. Under-diagnosis was defined as a pathological stage of >or=pT3a or positive surgical margins. The chi-square test was used to assess the differences, with P < 0.05 considered to indicate statistical significance. There were no significant differences in patient age or PSA levels between the study groups. There was over-diagnosis in the screening and referral groups in 17.4% and 8.9%, respectively, and under-diagnosis in 18.6% and 42.2%, respectively. This study suggests that patients with prostate cancer participating in a screening programme are less likely to be under-diagnosed or have extracapsular disease than their counterparts in a referral population, even in the same PSA range, after radical prostatectomy. Furthermore, there was more under-diagnosis in the referral group than over-diagnosis in the screened group.

Under-diagnosis and over-diagnosis of prostate cancer in a screening population with serum PSA 2 to 10 ng/ml: Pelzer AE, Bektic J, Akkad T, Ongarello S, Schaefer G, Schwentner C, Frauscher F, Bartsch G, Horninger W, Department of Urology, Medical University Innsbruck and Institute of Analytical Chemistry and Radiochemistry, Innsbruck, Austria

Purpose Since the implementation of widespread serum total prostate specific antigen based screening, the risk of prostate cancer over-diagnosis has become a concern. We evaluated the amount of possible over and under-diagnosis of prostate cancer in an asymptomatic screening population with a total prostate specific antigen of 2.0 to 3.9 (lower range) and 4.0 to 10.0 ng/ml (higher range). Materials and Methods A total of 680 patients with prostate cancer were included. Possible over-diagnosis was defined as Gleason score less than 7, pathological stage pT2a and negative surgical margins. Under-diagnosis was defined as pathological stage pT3 or greater, or positive surgical margins. Furthermore, insignificant tumors according to the Epstein criteria were evaluated in a small subset of patients for whom cancer volume information was available. Results In the lower and higher total prostate specific antigen ranges there was an over-diagnosis rate of 19.7% and 16.5%, and an under-diagnosis rate of 18.9% and 36.7%, respectively ( P Conclusions These data show that the reported estimates of over-diagnosis in the low total prostate specific antigen group are exaggerated in a screening population. Using our criteria, prostate cancer under-diagnosis occurs more frequently than over-diagnosis in the total prostate specific antigen range of 4.0 to 10 ng/ml.

Over- and Underdiagnosis of Prostate Cancer: The Dangers

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.