Prostate cancer overdiagnosis and overtreatment

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Prostate cancer screening aims to reduce mortality but leads to overdiagnosis of clinically insignificant disease.
• Overdiagnosis can result in overtreatment, causing significant long-term quality-of-life issues for patients.

Purpose of the Study:

• To review evidence on prostate cancer overdiagnosis and overtreatment due to screening.
• To explore and summarize solutions for managing overdiagnosis and overtreatment.

Main Methods:

• Review of extensive evidence on prostate cancer screening outcomes.
• Analysis of approaches to mitigate overdiagnosis and overtreatment.
• Summary of outcomes for implemented solutions.

Main Results:

• Prostate cancer screening reduces mortality but requires a high number to treat.
• Gleason 6 prostate cancer often lacks malignant hallmarks, yet some favorable-risk cases harbor higher-grade cancer.
• Repeat biopsy, serial PSA, and MRI can identify patients benefiting from treatment.

Conclusions:

• Active surveillance is a key solution to prostate cancer overdiagnosis and overtreatment.
• It allows personalized medicine, avoiding treatment for most favorable-risk patients.
• Definitive management is provided for the minority reclassified as higher-risk over time.