Writing
Prostate cancer rates in Europe have shown a significant increase since 1980. This could be an indication of overdiagnosis, according to a study published in The BMJ by Salvatore Vaccarella, of the International Agency for Research on Cancer in Lyon, France. The study suggests that this increase in incidence is largely due to the widespread adoption of prostate-specific antigen (PSA) testing. It indicates that these tests would have been applied predominantly opportunistically.
Overdiagnosis, according to experts, occurs when abnormalities are detected cancers that would likely not cause symptoms or death during the patient’s lifetimeThis situation can lead to unnecessary treatments, negatively affect quality of life and waste medical resources. The results of the study show a significant disparity between the increasing incidence of cases and the stability in prostate cancer mortality rates over the same period, reinforcing concerns about overdiagnosis.
Between 1980 and 2020, prostate cancer mortality rates remained much lower and less variable compared to incidence. This divergence, the researchers explain, underlines the decisive influence of PSA testing in increasing the number of detected cases, rather than in reducing deaths.
Study warns of need for careful design in implementation of future prostate cancer screening programs
The study warns of the need for careful design in the implementation of future population-based prostate cancer screening programmes to minimise the risks of overdiagnosis. Although the European Union has recently proposed new screening strategies, the report emphasizes the importance of having accurate and up-to-date data on national prostate cancer rates before implementing any new approach.
The analysis included incidence and mortality data for men aged 35–84 years in 26 European countries. Between 1990 and 2017, The incidence of prostate cancer has doubled in most of these countries, with significant variations by region. The largest increases were recorded in Northern Europe, France and the Baltic countries, with Lithuania showing the largest increase.
Despite these alarming incidence figures, mortality rates remained relatively low and constant, reinforcing the overdiagnosis hypothesis. The researchers conclude that rigorous monitoring and evaluation of the benefits and harms associated with PSA testing is crucial, especially in view of the possible implementation of large-scale screening programmes in Europe.
