Nomogram to determine individualized estimates of screen-detected prostate cancer overdiagnosis

January 6, 2014, Journal of the National Cancer Institute

Using a nomogram that incorporates age, Gleason score, and prostate-specific antigen (PSA) level at diagnosis, individual risks that a screen-detected prostate cancer has been overdiagnosed can be estimated, according to a new study published January 6 in the Journal of the National Cancer Institute.

The authors used a standard definition of overdiagnosis to refer to a cancer that would not have become symptomatic or clinically identifiable if it had not been detected by screening. Overdiagnosed cancers do not pose a risk to the patient and do not require treatment, which is associated with significant risks of impotence and . Previous studies have estimated the risk of overdiagnosis for the US population, with results ranging from 23% to 42% of screen detections. However, risks of overdiagnosis can vary considerably depending on the patient's age and tumor characteristics, highlighting the need for a personalized tool to predict the likelihood of overdiagnosis.

Roman Gulati, M.S., from the Division of Public Health Sciences at the Fred Hutchinson Cancer Research Center in Seattle, WA, and colleagues developed the overdiagnosis nomogram to help patients and clinicians make informed treatment decisions about screen-detected prostate cancers. The authors used a microsimulation model to generate virtual life histories for a representative population of US men between 1975 and 2005. Men who develop cancer can be detected based on elevated PSA levels or development of symptoms. The model used prostate cancer incidence data from the Surveillance, Epidemiology, and End Results registry to estimate risks of prostate cancer progression and detection in the absence and presence of PSA screening. A prediction model was then developed to predict individual chances of overdiagnosis (i.e., the chance that other-cause death would precede diagnosis in the absence of PSA screening) given information known at screen detection. The prediction model estimates that the chances of overdiagnosis range from 2.9% to 88.1% depending on patient age, PSA, and Gleason score.

The authors write, "It is hoped that the resulting , tailored to individual patient characteristics known at diagnosis, will provide useful information for patients and their physicians seeking to weigh the likely harms and benefits of the treatment options available for contemporary screen-detected prostate cancers."

In an accompanying editorial, Boris Freidlin, Ph.D. and Edward L. Korn, Ph.D., from the Biometric Research Branch, Division of Cancer Treatment and Diagnosis at the National Cancer Institute in Bethesda, MD, the editorialists caution that each step of the modeling described in the study by Gulati et al makes "multiple unverifiable assumptions that can produce bias." They write that microsimulation could still be useful to increase generalizability of results from randomized trial results. However, Freidlin and Korn question whether the Gulati et al model of the risk of overdiagnosis is useful in guiding treatment decisions of patients with screen-detected prostate cancer: "…once an individual has been screened and found to have prostate cancer, the relevant question is the outcomes of various treatments (treatment morbidity, prostate cancer symptoms and death), and not the probability of an event [detection of ] that could have happened if the individual had not been screened."

Explore further: Alternative PSA screening strategies could reduce harm

Related Stories

Alternative PSA screening strategies could reduce harm

February 5, 2013
(HealthDay)—Compared with standard screening, alternative prostate-specific antigen (PSA) screening strategies could maintain good prostate cancer detection rates while reducing overdiagnoses and unnecessary biopsies, according ...

NLST data highlight probability of lung cancer overdiagnosis with low-dose CT screening

December 9, 2013
Data from the National Lung Cancer Screening Trial (NLST)—conducted by the American College of Radiology Imaging Network and National Cancer Institute Lung Screening Study—provided researchers the opportunity to investigate ...

New early detection test for prostate cancer: Mi-Prostate Score test improves on PSA for predicting cancer

September 26, 2013
More than 1 million men will undergo a prostate biopsy this year, but only about one-fifth of those biopsies will result in a cancer diagnosis.

Organized screening for prostate cancer does more harm than good

September 30, 2013
Prostate cancer screening using the prostate-specific antigen (PSA) test is widely used in France despite a lack of evidence showing that it reduces cancer deaths. Now, researchers have shown that men experience more harm ...

A new screening method for prostate cancer

February 2, 2012
A new study by NYU Langone Medical Center and Northwestern University Feinberg School of Medicine shows novel PSA velocity (PSAV) risk count testing may provide a more effective way for physicians to screen men for clinically ...

The role of radical prostatectomy in patients with prostate cancer

February 14, 2013
Even in the presence of screening, there is benefit to radical prostatectomy (RP) in prostate cancer patients, however, the benefit is limited to a subgroup of patients and can take years to become evident according to a ...

Recommended for you

T-cells engineered to outsmart tumors induce clinical responses in relapsed Hodgkin lymphoma

January 16, 2018
WASHINGTON-(Jan. 16, 2018)-Tumors have come up with ingenious strategies that enable them to evade detection and destruction by the immune system. So, a research team that includes Children's National Health System clinician-researchers ...

Researchers identify new treatment target for melanoma

January 16, 2018
Researchers in the Perelman School of Medicine at the University of Pennsylvania have identified a new therapeutic target for the treatment of melanoma. For decades, research has associated female sex and a history of previous ...

More evidence of link between severe gum disease and cancer risk

January 16, 2018
Data collected during a long-term health study provides additional evidence for a link between increased risk of cancer in individuals with advanced gum disease, according to a new collaborative study led by epidemiologists ...

Researchers develop a remote-controlled cancer immunotherapy system

January 15, 2018
A team of researchers has developed an ultrasound-based system that can non-invasively and remotely control genetic processes in live immune T cells so that they recognize and kill cancer cells.

Dietary fat, changes in fat metabolism may promote prostate cancer metastasis

January 15, 2018
Prostate tumors tend to be what scientists call "indolent" - so slow-growing and self-contained that many affected men die with prostate cancer, not of it. But for the percentage of men whose prostate tumors metastasize, ...

Pancreatic tumors may require a one-two-three punch

January 15, 2018
One of the many difficult things about pancreatic cancer is that tumors are resistant to most treatments because of their unique density and cell composition. However, in a new Wilmot Cancer Institute study, scientists discovered ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.