|Underdiagnosis More of a Problem In Prostate Cancer Than Overdiagnosis
Since prostate cancer diagnosis using the PSA test (called the PSA era), we’ve seen a 32.5% decrease in death rates from prostate cancer and a 75% decrease in metastic cancer (that has spread beyond the prostate) at time of diagnosis.
When our study group used PSA of 4 ng/mL as the biopsy threshold, 30% of the men had cancers with advanced pathology features and 1.3% had features that would indicate they might be overdiagnosed.
Another finding was that lowering the PSA threshold for biopsy from 4 to 2.5 resulted in an overall 4% decrease I the rate of underdiagnosis and a corresponding 7% increase in 5-year progression-free survival.
*overdiagnosed (Ohori): a cancer volume less than 0.5cc’s, organ-confined, and no Gleason pattern o 4 or 5 (Note: I feel it is impossible to predict that an individual cancer is insignificant in any given patient, particularly a young patient, because tumors can develop mutations and become more aggressive over time.)
**underdiagnosed (Catalona): at radical prostatectomy found to have advanced pathology features including: tumor outside the prostate, positive surgical margins,or lymph node metastases