> The problem of overdiagnosis has received an increasing amount of attention in the field of cancer screening. It is a particularly large issue for prostate cancer because prostate cancer can have a long period when it is detectable but asymptomatic. As early as the 1980’s, before the use of prostate-specific antigen (PSA) for early detection of prostate cancer, overdiagnosis was recognized as an important issue for prostate cancer screening that used digital rectal examinations.1
> Individuals with cancer that is overdiagnosed do not benefit from having their cancer detected by screening but they suffer from the harms of evaluations done to establish that cancer exists and the harms of treatment for the cancer. The harms of treating prostate cancer can be both serious and common.2, 3 Even if individuals with screen-detected prostate cancer do not undergo treatment, they may suffer from anxiety and diminished well-being because of the cancer diagnosis and they may be burdened by the testing and interventions used to monitor the cancer. Uncertainties regarding the benefit of PSA screening in reducing prostate cancer mortality in randomized trials2 and evidence that the incidence of prostate cancer increased dramatically with the adoption of PSA screening,4- 6 have moved overdiagnosis to the forefront of discussions about whether and how to screen for prostate cancer.
