Evidence map›Paper›PMID 36811453›Full record

ReviewThe Prostate2023

Low-risk prostate lesions: An evidence review to inform discussion on losing the "cancer" label.

Caitlin R Semsarian, Tara Ma, Brooke Nickel, Alexandra Barratt, Murali Varma, Brett Delahunt, Jeremy Millar, Lisa Parker, Paul Glasziou, Katy J L Bell

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in The Prostate, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Caitlin R SemsarianSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.ORCID 0000-0001-8691-0248
Tara MaSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Brooke NickelSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Alexandra BarrattSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Murali VarmaDepartment of Cellular Pathology, University Hospital of Wales, Cardiff, UK.
Brett DelahuntWellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
Jeremy MillarAlfred Health Radiation Oncology, The Alfred, Melbourne, Australia.
Lisa ParkerCharles Perkins Centre, Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Paul GlasziouInstitute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
Katy J L BellSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.

Funding

National Health and Medical Research Council
6 · The paper itself

Abstract

backgroundActive surveillance (AS) mitigates harms from overtreatment of low-risk prostate lesions. Recalibration of diagnostic thresholds to redefine which prostate lesions are considered "cancer" and/or adopting alternative diagnostic labels could increase AS uptake and continuation.

methodsWe searched PubMed and EMBASE to October 2021 for evidence on: (1) clinical outcomes of AS, (2) subclinical prostate cancer at autopsy, (3) reproducibility of histopathological diagnosis, and (4) diagnostic drift. Evidence is presented via narrative synthesis.

resultsAS: one systematic review (13 studies) of men undergoing AS found that prostate cancer-specific mortality was 0%-6% at 15 years. There was eventual termination of AS and conversion to treatment in 45%-66% of men. Four additional cohort studies reported very low rates of metastasis (0%-2.1%) and prostate cancer-specific mortality (0%-0.1%) over follow-up to 15 years. Overall, AS was terminated without medical indication in 1%-9% of men. Subclinical reservoir: 1 systematic review (29 studies) estimated that the subclinical cancer prevalence was 5% at <30 years, and increased nonlinearly to 59% by >79 years. Four additional autopsy studies (mean age: 54-72 years) reported prevalences of 12%-43%. Reproducibility: 1 recent well-conducted study found high reproducibility for low-risk prostate cancer diagnosis, but this was more variable in 7 other studies. Diagnostic drift: 4 studies provided consistent evidence of diagnostic drift, with the most recent (published 2020) reporting that 66% of cases were upgraded and 3% were downgraded when using contemporary diagnostic criteria compared to original diagnoses (1985-1995).

conclusionsEvidence collated may inform discussion of diagnostic changes for low-risk prostate lesions.

Indexed as

ProstateProstatic NeoplasmsAgedHumansMaleMiddle AgedProstate-Specific AntigenReproducibility of ResultsProstate-Specific Antigenclassificationdiagnosispathologyprostateterminologytreatment

Identifiers

PMID36811453
PMCPMC10952636

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.