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UROSCAN |
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| Year : 2006 | Volume
: 22
| Issue : 1 | Page : 82-83 |
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Autopsy prostate cancer: Pre and post PSA era
R Kumar, R Yadav
Department of Urology, All India Institute of Medical Sciences, New Delhi, India
Correspondence Address:
R Kumar
Department of Urology, All India Institute of Medical Sciences, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Kumar R, Yadav R. Autopsy prostate cancer: Pre and post PSA era. Indian J Urol 2006;22:82-3 |
Konety BR, Bird VY, Deorah S, Dahmoush L.Comparison of the incidence of latent prostate cancer detected at autopsy before and after the prostate specific antigen era.J Urol. 2005;174:1785-8.
Summary
Widespread use of PSA screening may have led to the clinical diagnosis of prostate cancer in men who in the pre-PSA era and they would have remained undiagnosed with latent prostate cancer. In order to test this hypothesis, the authors compared the relative frequency of new prostate cancer, detected at autopsy in 2 groups of men from the pre-PSA and post-PSA eras (1955 to 1960 and 1991 to 2001, respectively). They reviewed their institutional database for autopsies conducted in these two periods, in all men above the age of 40 years. The most common cause of death in both periods was coronary artery disease. Prostate pathology slides were retrieved for men, whose autopsy reports had a diagnosis of latent prostate cancer. These slides were reviewed for confirmation of diagnosis, stage and grade of tumor. Between 1955 and 1960, the frequency of latent prostate cancer was 76 of 1578 (4.8%), compared to 16 of 1380 (1.2%) between 1991 and 2001 ( P < 0.001). 17 men in the pre-PSA era had a stage T3 or greater tumor on autopsy, while none of the post-PSA era latent tumor was T3 disease. 54 out of 76 patients in the pre-PSA era had Gleason score 7 or greater tumors, while 4 out of 14 post PSA era patients had tumors of this grade. The authors concluded that the prevalence of autopsy-detected, latent prostate cancer has decreased over time. They believe that this could be due to the widespread use of screening methods, rather than a true decrease.
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While population- based studies suggest that the incidence of prostate cancer in the population has decreased in the last 25 years.[1] there has been an increase the number of clinically diagnosed prostate cancers and of patients reporting for treatment. PSA-based screening has been responsible for this shift. and while this has helped diagnose and treat early the patients who would suffer morbidity and mortality from their cancer, it has also raised the possibility that we may be over-diagnosing and thus over-treating patients who may have died with latent prostate cancer, never needing treatment. One of the expected outcomes of such over-diagnosis would be a decline in the incidence of autopsy-detected latent cancer. This study, though retrospective, attempts to answer this questions and their finding, that there has indeed been a decline in the incidence of latent prostate cancer and would tend to support the hypothesis, that we are over-diagnosing prostate cancer. However, it should be noted, that 23% of tumors in the pre-PSA era were stage T3 or higher, while none in the post PSA era were such high stage. Similarly, 54% patients in the pre-PSA era had Gleason grade 7 or higher disease, compared to 29% in the post PSA era. The authors fail to report the cause of death in these sub groups of patients and it is possible that the more aggressive/advanced tumor in these patients may have contributed to their mortality. It also suggests that PSA screening tends to pick up more advanced/aggressive tumors which get treated and thus their numbers decline in the autopsy series. This would be a beneficial effect of screening and would indeed support the use of screening. Unfortunately, this dilemma can be answered only through a prospective, randomized trial, which may not be feasible, considering the ethical issues of conservative management of T1c prostate cancer.
| References | | |
| 1. | Shibata A, Ma J, Whittemore AS. Prostate cancer incidence and mortality in the United States and the United Kingdom. J Natl Cancer Inst 1998; 90:1230  |
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