Prevalence of incidental prostate cancer: A systematic review of autopsy studies.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of observational autopsy prevalence studies.
PubMed 25821151 · doi:10.1002/ijc.29538
What was done
A systematic review and meta-analysis of autopsy studies (published 1948–2013) to determine age-specific prevalence of incidental prostate cancer in men dying of other causes. Databases searched included Medline and Embase alongside citation chasing and author contact. Clinical, pathological, and validity data were extracted using standardized forms, and age-specific prevalence rates were pooled using random-effects logistic regression models.
What was found
Across 29 included studies, incidental prostate cancer was present in all studied populations with no clear time trends. Prevalence increased with each decade of age (OR = 1.7, 95% CI: 1.6–1.8) and was higher in studies using the Gleason score (OR = 2.0, 95% CI: 1.1–3.7). Estimated mean prevalence grew nonlinearly from 5% (95% CI: 3–8%) in men aged <30 years to 59% (95% CI: 48–71%) in men aged >79 years. There was substantial variation in estimated prevalence between different populations.
Why it matters
These findings quantify the vast reservoir of asymptomatic, subclinical prostate cancer across all adult age groups, explaining why screening programs carry a high risk of overdiagnosing nonprogressive tumors.
Limits
The abstract does not state the total number of autopsies pooled across the 29 studies. Substantial variation existed across populations and histological assessment methods (e.g., Gleason vs. non-Gleason) over a 65-year period, and autopsy data cannot directly distinguish clinically indolent from potentially lethal latent disease.
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- context Nearly every person has cancer cells living in their body at any given time.