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NHMRC Grant Number: APP1013390, 527500 and 633003
Prostate cancer screening may detect non-progressive cancers, leading to over-diagnosis and over-treatment. The potential for over-diagnosis can be assessed from the reservoir of prostate cancer in autopsy studies that report incidental prostate cancer rates in men who died of other causes. We aimed to estimate the age-specific incidental cancer prevalence from all published autopsy studies.
We identified eligible studies by: searches of Medline and Embase, forward and backward citation searches, and contacting authors. We screened the titles and abstracts of all articles; checked the full text articles for eligibility; and extracted clinical and pathology data using standardized forms. We extracted: mean cancer prevalence, age-specific cancer prevalence, and validity measures, then pooled data from all studies using logistic regression models with random effects.
The 29 studies included in the review dated from 1948 to 2013. Incidental cancer was detected in all populations, with no obvious time trends in prevalence. Prostate cancer prevalence increased with each decade of age, OR =1.7 (1.6 – 1.8) and was higher in studies that used the Gleason score, OR=2.0 (1.1 – 3.7). No other factors were significantly predictive. The estimated mean cancer prevalence increased in a non-linear fashion from 5% (95% CI 3 – 8%) at age59% (95% CI 48 – 71%) by age >79 years. There was substantial variation between populations in estimated cancer prevalence.
There is a substantial reservoir of incidental prostate cancer which increases with age. The high risk of over-diagnosis limits the usefulness of prostate cancer screening. This article is protected by Prostate cancer screening may detect non-progressive cancers, leading to over-diagnosis and
This document has been peer reviewed.