Prostate Cancer Overdiagnosis and Overtreatment

Abstract

The widespread use of serum prostate-specific antigen (PSA) testing has had profound effects on the diagnosis and treatment of prostate cancers since its introduction in the 1980s (1). As a result of PSA-based improvements in diagnosis and increased levels of diagnostic activity, prostate cancer incidence rates rose abruptly at a rate unprecedented in the history of oncology in the United States. The magnitude of change seen in prostate cancer incidence during the 1990s has not previously been observed in any other cancer (2). Factors that contributed to the unprecedented increase in prostate cancer incidence include the high preclinical prevalence of prostate cancer and the increased detection of prostate cancer using PSA testing resulting from widespread acceptance and use of the PSA test. It appears unlikely that changes in incidence of this magnitude will be seen again for prostate cancer or any other malignancy.