title: Over-diagnosis and under-diagnosis of screen- vs non-screen-detected prostate cancers with in men with prostate-specific antigen levels of 2.0-10.0 ng/mL.
abstract: OBJECTIVE
  To evaluate possible over- and under-diagnosis of prostate cancer in a screened vs a referral population in the same range of prostate-specific antigen (PSA).
  
  
  METHODS
  In all, 1445 patients undergoing radical prostatectomy and with a PSA level of <10 ng/mL were evaluated; 237 were from outside Tyrol (Austria) and represented the unscreened group, and 1208 were Tyrolean screening volunteers. Over-diagnosis was defined as a pathological stage of pT2a and a Gleason score of <7 with no positive surgical margins. Under-diagnosis was defined as a pathological stage of >or=pT3a or positive surgical margins. The chi-square test was used to assess the differences, with P < 0.05 considered to indicate statistical significance.
  
  
  RESULTS
  There were no significant differences in patient age or PSA levels between the study groups. There was over-diagnosis in the screening and referral groups in 17.4% and 8.9%, respectively, and under-diagnosis in 18.6% and 42.2%, respectively.
  
  
  CONCLUSIONS
  This study suggests that patients with prostate cancer participating in a screening programme are less likely to be under-diagnosed or have extracapsular disease than their counterparts in a referral population, even in the same PSA range, after radical prostatectomy. Furthermore, there was more under-diagnosis in the referral group than over-diagnosis in the screened group.
authors.affiliation: Department of Urology, Medical University Innsbruck, Austria. alexandre.pelzer@uki.at
authors.forename: Alexandre E
authors.initials: AE
authors.lastname: Pelzer
authors.forename: Daniela
authors.initials: D
authors.lastname: Colleselli
authors.forename: Jasmin
authors.initials: J
authors.lastname: Bektic
authors.forename: Georg
authors.initials: G
authors.lastname: Schaefer
authors.forename: Stefano
authors.initials: S
authors.lastname: Ongarello
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
authors.forename: Fritz
authors.initials: F
authors.lastname: Aigner
authors.forename: Michael
authors.initials: M
authors.lastname: Mitterberger
authors.forename: Eberhard
authors.initials: E
authors.lastname: Steiner
authors.forename: Georg
authors.initials: G
authors.lastname: Bartsch
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Horninger
mesh_terms: D000328:Adult; D000368:Aged; D001317:Austria / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D012017:Referral and Consultation
chemical_list: D017430:Prostate-Specific Antigen