Autopsy studies have demonstrated a high prevalence of asymptomatic localized prostate cancer among men who die from other causes. This observation leads some critics to worry that prostate cancer screening leads to unnecessarily aggressive intervention in many men who would not develop symptomatic disease within their lifetimes.
General autopsy studies might include disproportionately large numbers of debilitated men. Presuming that organ donors would represent a healthier population, pathologists from Pittsburgh carefully examined the prostates of 340 men who were accepted as organ donors after they died unexpectedly from trauma, homicide, suicide, stroke, or cardiac arrest. None had known prostate cancer. The prevalence of prostate cancer was 0.5%, 23%, 35%, and 46% among men in the <50, 50–59, 60–69, and
70 age groups, respectively (only 11 men were in the 
70 group). In addition, about 20% of men in their 40s, 50s, and 60s had high-grade prostate intraepithelial neoplasia without cancer.Comment: These findings corroborate autopsy data: Asymptomatic prostate cancer is very common among men older than 50. The authors of this report incorrectly conclude that their data "confirm the value of screening for prostate carcinoma after age 50." A more appropriate conclusion would be that the prevalence of "silent" prostate cancer in the general population is high and that the value of routine prostate-specific antigen (PSA) screening will remain unclear until ongoing randomized trials are completed.
— Allan S. Brett, MD
Published in Journal Watch General Medicine March 11, 2008
Citation(s):
Yin M et al. Prevalence of incidental prostate cancer in the general population: A study of healthy organ donors. J Urol 2008 Mar; 179:892.