Prostate cancer overdiagnosis risk increases substantially in older men

Researchers at Queen Mary University of London have found that the likelihood of prostate cancer overdiagnosis – the detection of a cancer that would never have been diagnosed during a patient's lifetime but for PSA screening – is low in younger men but rises substantially with old age.

The study, which aimed to estimate the impact of age on overdiagnosis of prostate cancer 15 years after screening stops, analysed long-term follow-up data from the UK CAP (Cluster Randomised Trial of PSA Testing for Prostate cancer) trial, alongside English male mortality rates.

However, when competing mortality (ie, the risk of dying from something other than prostate cancer) was factored in, the team found that the picture changed markedly by age:

• Men diagnosed at age 50 had a 16% chance that their cancer would never have been detected within 15 years 
• This rose to 32% for men diagnosed aged 70

And rose further to 58% for men diagnosed at age 80.

The findings suggest that prostate cancer screening and PSA testing is more appropriate for men in their 50s and early 60s, as there are likely to be low levels of overdiagnosis in this group.

Dr Adam Brentnall, Reader in Biostatistics at Queen Mary's Wolfson Institute of Population Health and lead author of the studyThese findings suggest the need for more targeted, age-informed PSA testing or prostate cancer screening policies, including reexamining PSA testing policies in settings where they have led to high rates of opportunistic screening in older men, like the UK.

Source:

Queen Mary University of London

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