Are T1c tumors different from incidental tumors found at autopsy? The risk and reality of overdetection.

The wisdom governing contemporary prostate cancer screening or early detection programs continues to be scrutinized. Although the mild increase in death rate speaks for itself, the enormously disparate and accelerating incidence rates have attained widespread attention. The abrupt recent downstage migration suggests that T1c lesions may be the arguable culprit. For more than 50 years, we have known that incidental prostate cancers found at autopsy are very common. Given these odds, it is not surprising that these cancers will be found antemortem. Mathematical models correctly predict the discovery of small-volume cancers with multiple biopsies. Although there are some anticipated differences between T1c and incidental tumors found at autopsy, the overlap is predictably large, suggesting that a conservative answer to the question posed in the title is: Maybe yes, but often not much.