{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T23:49:44Z","timestamp":1769903384647,"version":"3.49.0"},"posted":{"date-parts":[[2026,1,28]]},"group-title":"Epidemiology","reference-count":33,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,1,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>Prostate cancer overdiagnosis is detection of prostate cancer through PSA testing that otherwise would not have been diagnosed within the patient\u2019s lifetime. It is a major concern to policymakers due to its impact on quality of life. We used long-term followup data from the CAP randomised trial of a one-off screen, and English male competing mortality rates (2021-23), to estimate the impact of age on excess prostate cancer incidence within 15 years (\u2018overdiagnosis\u2019) using competing risks methods. In total, 2249 (1.19%) of 189,386 men invited for a PSA test in CAP had cancer detected at the one-off screen. Prostate cancer cumulative incidence at 15 years was 7.08% (95%CI 6.95 to 7.21%) in those invited to screening, compared with 6.94% (95%CI 6.82 to 7.06%) in the control arm; an absolute excess incidence difference of 0.14% (95%CI -0.04% to 0.37%). Excess net incidence to 15 years was 0.14\/1.19 = 11.7% (95%CI 0.0% to 26.7%) of cases detected at a single prevalent screen. Accounting for competing mortality, English men diagnosed aged 50 years were projected to have a 16% chance the cancer would not have been detected within 15 years, rising to 32% aged 70 years and 58% aged 80 years. Thus, prostate cancer overdiagnosis rises substantially with age due to competing mortality, and is relatively low for younger men. Accordingly, opportunistic testing policies should be re-examined in settings where they have led to high rates of screening in older men.<\/jats:p>","DOI":"10.64898\/2026.01.26.26344830","type":"posted-content","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T06:15:18Z","timestamp":1769667318000},"source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the impact of age on prostate cancer overdiagnosis using long-term follow-up from a randomised trial"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6327-4357","authenticated-orcid":false,"given":"Adam R","family":"Brentnall","sequence":"first","affiliation":[{"name":"Wolfson Institute of Population Health, Queen Mary University of London, Charter-house Square, London, EC1M 6BQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matejka","family":"Rebolj","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Queen Mary University of London, Charter-house Square, London, EC1M 6BQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Sasieni","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Queen Mary University of London, Charter-house Square, London, EC1M 6BQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Garth","family":"Funston","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Queen Mary University of London, Charter-house Square, London, EC1M 6BQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rhian","family":"Gabe","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Queen Mary University of London, Charter-house Square, London, EC1M 6BQ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Vickers","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center, New York, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026013104050602000_2026.01.26.26344830v1.1","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.1001\/jama.2024.4011","article-title":"Prostate-specific antigen screening and 15-year prostate cancer mortality: A secondary analysis of the cap randomized clinical trial","volume":"331","year":"2024","journal-title":"JAMA"},{"key":"2026013104050602000_2026.01.26.26344830v1.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2503223"},{"key":"2026013104050602000_2026.01.26.26344830v1.3","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.euros.2024.09.003","article-title":"Risk-stratified approach to implementing population-based prostate cancer screening in five pilot sites in the european union: A protocol for the praise-u project","volume":"70","year":"2024","journal-title":"European Urology Open Science"},{"key":"2026013104050602000_2026.01.26.26344830v1.4","unstructured":"UK NSC Screening Recommendation: Prostate Cancer. https:\/\/view-health-screening-recommendations.service.gov.uk\/prostate-cancer\/ 2025. 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