title: Overdetection in screening for prostate cancer.
abstract: OBJECTIVE
  To describe mechanisms behind and extent of overdetection in prostate cancer screening as well as possible ways to avoid unnecessary overdiagnosis.
  
  
  RESULTS
  Overdetection and overtreatment is common in many areas of modern medicine. Current prostate-specific antigen (PSA) testing has resulted in a marked stage shift to early stages, which, together with improvements in treatment, has resulted in a substantial decrease in prostate cancer mortality. However, nonselective, widespread PSA-testing followed by liberal biopsy criteria has resulted in a high rate of overdiagnosis, which constitutes one major obstacle to introducing population-based screening.
  
  
  CONCLUSIONS
  Several steps are needed to decrease overdetection: do not screen elderly men unlikely to benefit, do not biopsy without a compelling reason, differentiate screening interval according to risk, work-up benign prostate disease by using reflex tests and/or complementary biomarkers, and focus on screening men at high risk for a life-threatening disease, for example evaluate men with above-median PSA levels in midlife. Recent results indicate that use of MRI to select men for biopsy and using only lesion-directed biopsies may be one way forward. However, more studies are needed before firm recommendations can be made. When the diagnosis is made, treat only those who need treatment. Tailor treatment to tumor biology and patient characteristics, and offer active surveillance to eligible men with low-risk tumors, especially small-volume disease, as the first management.
authors.affiliation: aDepartment of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden bDepartment of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
authors.forename: Sigrid
authors.initials: S
authors.lastname: Carlsson
mesh_terms: D001706:Biopsy; D055088:Early Detection of Cancer / Q000379:methods; D006801:Humans; D007610:Kallikreins / Q000097:blood; D008297:Male; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D019564:Unnecessary Procedures
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen