Which screening test is most associated with overdiagnosis in prostate cancer?

The prostate-specific antigen (PSA) test is most associated with overdiagnosis in prostate cancer because it can lead to the detection of tumors that may not have caused any symptoms or health problems during a man's lifetime. PSA levels can be elevated due to a variety of factors, including benign conditions such as prostatitis or benign prostatic hyperplasia, in addition to cancer.

As a result, many men with elevated PSA levels are subjected to additional testing, including biopsies, which can ultimately identify small, indolent tumors that are unlikely to impact the patient's health or lifespan. This scenario increases the risk of overdiagnosis, where men are treated for cancers that may not have needed intervention, potentially exposing them to unnecessary treatments and their associated side effects.

In contrast, screening methods like the digital rectal exam, transrectal ultrasound, and bone scan do not have the same level of association with overdiagnosis as the PSA test. While they can be used in the diagnostic process, they do not inherently lead to the same kind of over-identification of low-risk cancers as the PSA screening does. Hence, the connection between PSA testing and overdiagnosis is well-documented in the medical literature, making it the correct answer in this context.