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Most prostate cancer is now detected at a localized stage, presumably because of screening for prostate-specific antigen (PSA), and the 5-year survival rate for patients with local disease is nearly 100%. Some experts are now concerned about overdiagnosis and overly aggressive treatment, yet others argue for lowering the PSA threshold for biopsy even further.
To explore this issue, researchers used a national cancer epidemiology database to assess the care of nearly 124,000 patients who had prostate cancer that was diagnosed between 2004 and 2006. Among the 14% of men with PSA levels ≤4.0 ng/mL, 54% had low-risk disease (stage ≤T2a; Gleason score, ≤6). Of all cancer patients with PSA levels ≤4.0 ng/mL, 44% were treated with radical prostatec…