{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T15:26:39Z","timestamp":1768922799813,"version":"3.49.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI20\/01334"],"award-info":[{"award-number":["PI20\/01334"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Overdiagnosis in PSA-based prostate cancer (PCa) screening is primarily studied in younger, healthier populations from clinical trials. This study aimed to evaluate the probability of overdiagnosis in PCa screening within a clinical practice context, focusing on its relationship with PSA levels, Gleason scores, and subsequent clinical procedures.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a retrospective cohort analysis of 1,070 asymptomatic men over 40 years old diagnosed with PCa between 2004 and 2022, following a positive PSA test. The patients were followed until December 31, 2022, with a median follow-up time of 5.7 years (IQR 3.2\u20138.6). The primary outcome was the probability of overdiagnosis, assessed through life expectancy and the Charlson Comorbidity Index, considering lead times of 5, 10, and 15 years.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We found that patients with PSA levels &gt;10 ng\/dL and\/or Gleason scores \u22658 were generally older and had more comorbidities than those with PSA levels 4\u201310 ng\/dL and\/or Gleason scores \u22647. The probability of overdiagnosis was significantly higher in patients with PSA levels &gt;10 ng\/dL (41.4%, IQR 21.5\u201373.9) and Gleason scores \u22658 (42.6%, IQR 14.9\u201338.9), compared to those with PSA levels 4\u201310 ng\/dL (20.1%, IQR 12.8\u201330.4) and Gleason scores \u22647 (26.6%, IQR 23.6\u201368.6). Notably, 71.7% of patients did not receive pharmacological treatment. Patients with higher PSA levels also experienced greater radiation exposure from diagnostic imaging (median 19.9 mSv vs. 14.7 mSv, p = 0.004).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>These findings underscore the high likelihood of overdiagnosis in older patients with elevated PSA levels and significant comorbidities, highlighting the need for careful consideration of patient comorbidities before PSA testing.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0315979","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T18:26:14Z","timestamp":1739989574000},"page":"e0315979","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of patients\u2019 age and comorbidities on prostate cancer overdiagnosis in clinical practice"],"prefix":"10.1371","volume":"20","author":[{"given":"Abraham","family":"Beltr\u00e1n","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucy","family":"Parker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Moral-P\u00e9rez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Pablo","family":"Caballero-Romeu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Chilet-Rosell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ildefonso","family":"Hern\u00e1ndez-Aguado","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pablo","family":"Alonso-Coello","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1886-466X","authenticated-orcid":true,"given":"Elena","family":"Ronda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"G\u00f3mez-P\u00e9rez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1665-0860","authenticated-orcid":true,"given":"Blanca","family":"Lumbreras","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,2,19]]},"reference":[{"issue":"6","key":"pone.0315979.ref001","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.eururo.2013.12.062","article-title":"Overdiagnosis and overtreatment of prostate cancer","volume":"65","author":"S Loeb","year":"2014","journal-title":"Eur Urol"},{"key":"pone.0315979.ref002","doi-asserted-by":"crossref","first-page":"e3502","DOI":"10.1136\/bmj.e3502","article-title":"Preventing overdiagnosis: how to stop harming the healthy","volume":"344","author":"R Moynihan","year":"2012","journal-title":"BMJ"},{"issue":"6","key":"pone.0315979.ref003","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1093\/jnci\/djp001","article-title":"Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context","volume":"101","author":"G Draisma","year":"2009","journal-title":"J Natl Cancer Inst"},{"key":"pone.0315979.ref004","doi-asserted-by":"crossref","first-page":"100","DOI":"10.3322\/caac.21392","article-title":"Cancer screening in the United States, 2017: a review of current American Cancer Society guidelines and current issues in cancer screening","volume":"67","author":"RA Smith","year":"2017","journal-title":"Cancer J. 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