Autopsy prostate cancer: Pre and post PSA era

Kumar, R.; Yadav, R.
January 2006
Indian Journal of Urology;Jan-Mar2006, Vol. 22 Issue 1, p82
Academic Journal
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 autopsydetected, 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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