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What chance do we have to decrease prostate cancer overdiagnosis and overtreatment? A narrative review.

Francesco Ziglioli1, Giorgia Granelli, Domenico Cavalieri

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Accurate prostate cancer diagnosis remains challenging, often leading to overtreatment. This review explores tests and methods to better predict cancer aggressiveness, aiming to reduce unnecessary treatments and avoid missed diagnoses.

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Area of Science:

  • Urology
  • Oncology
  • Biochemistry

Background:

  • Prostate cancer management is controversial due to difficulties distinguishing clinically significant from insignificant disease.
  • Current diagnostic tools often fail to predict cancer aggressiveness, leading to potential overdiagnosis and overtreatment.
  • There is a critical need for reliable methods to assess prostate cancer's clinical significance at diagnosis.

Purpose of the Study:

  • To review existing tests and diagnostic methods for predicting prostate cancer aggressiveness.
  • To provide knowledge on tools that can aid in reducing overdiagnosis and overtreatment.
  • To optimize pre-treatment work-up and prevent missed diagnoses of significant prostate cancers.

Main Methods:

  • Review of scientific literature on diagnostic tests and biomarkers for prostate cancer.
  • Analysis of prostate-specific antigen (PSA) derivatives and immunocomplexes.
  • Evaluation of various diagnostic methods for predicting clinical aggressiveness.

Main Results:

  • Several indexes, PSA derivatives, and diagnostic methods have been proposed to aid clinical decision-making.
  • These tools, when used appropriately, can support the reduction of unnecessary treatments.
  • Effective utilization can help prevent both overtreatment and the underdiagnosis of aggressive cancers.

Conclusions:

  • A thorough understanding of available diagnostic tools is crucial for managing prostate cancer.
  • Implementing these methods can help mitigate treatment-related morbidities and improve patient outcomes.
  • Optimizing the pre-treatment work-up is essential for accurate prostate cancer management.