To the Editor: We are concerned by conclusions drawn by Del Mar and colleagues,1 in stating that because some autopsy studies have claimed more than 50% prevalence of latent prostate cancer in men aged over 60 years, this could be considered normal, and that these latent cancers result in a high level of overdiagnosis of prostate cancer. The study cited was conducted at Wayne State University, Detroit, in the early 1990s and indeed showed that as many as 70% of African American men in that age group showed latent prostate cancer.2 However, other articles relating to these data show that the lesions were very small, on average less than 2.3 mm, and were of a very low grade, mainly with a Gleason score of 2–5.3,4
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- 1. Del Mar CB, Glasziou PP, Hirst GH, et al. Should we screen for prostate cancer? A re-examination of the evidence. Med J Aust 2013; 198: 525-527. <MJA full text>
- 2. Sakr WA, Grignon DJ, Haas GP, et al. Age and racial distribution of prostatic intraepithelial neoplasia. Eur Urol 1996; 30: 138-144.
- 3. Sakr WA, Haas GP, Cassin BF, et al. The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients. J Urol 1993; 150: 379-385.
- 4. Sakr WA, Grignon DJ, Crissman JD, et al. High grade prostatic intraepithelial neoplasia (HGPIN) and prostatic adenocarcinoma between the ages of 20-69: an autopsy study of 249 cases. In Vivo 1994; 8: 439-443.
- 5. Bostwick DG, Chang L. Overdiagnosis of prostatic adenocarcinoma. Semin Urol Oncol 1999; 17: 199-205.
- 6. Yin M, Bastacky S, Chandran U, et al. Prevalence of Incidental prostate cancer in the general population: a study of healthy organ donors. J Urol 2008; 179: 892-895; discussion 895.
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