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Decline in the overall incidence of regional‐distant prostate cancer in Olmsted County, MN, 1980–2000
Author(s) -
Mullan Rebecca J.,
Jacobsen Steven J.,
Bergstralh Erik J.,
Slezak Jeffrey M.,
Tindall Donald J.,
Lieber Michael M.,
Roberts Rosebud O.
Publication year - 2005
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2005.05445.x
Subject(s) - incidence (geometry) , prostate cancer , cancer incidence , cancer , demography , medicine , sociology , mathematics , geometry
There are many papers in this section covering a wide range of topics relating to prostate, kidney and bladder cancer. Authors from the Mayo Clinic evaluate trends in the incidence of regional‐distant prostate cancer before and after the introduction of PSA screening in 1987 in their residents in Olmsted County. They found a decrease in the overall incidence of this type of disease, regardless of stage at initial diagnosis. Authors from the Royal Marsden describe their policy of active surveillance and contrast it with watchful waiting, differentiating clearly between the policies. These are early results, but they make interesting reading. The authors mention ongoing studies which seek to optimise the active surveillance protocol. OBJECTIVE To describe trends in the incidence of regional‐distant prostate cancer over the entire course of the disease, before and after the introduction of prostate‐specific antigen screening in 1987. PATIENTS AND METHODS All residents of Olmsted County, MN, USA, with a diagnosis of prostate cancer from 1964 to 2000 were identified using the resources of the Rochester Epidemiology Project. Their community medical records were examined to identify men with documented evidence of locally advanced (T3/4 or N+ disease) or metastatic prostate cancer between 1980 and 2000. RESULTS In all, 407 men had regional‐distant prostate cancer, based on clinical or pathological staging at the time of initial diagnosis of prostate cancer and/or on radiological information over the entire course of their illness. The age‐adjusted incidence per 100 000 men increased from 47.4 in 1980–86 to 65.8 in 1987–93, and declined to 33.3 in 1994–2000 ( P < 0.001). Based on clinical and radiological information over the entire course of illness (268 men) the age‐adjusted incidence of regional‐distant disease was 42.3 in 1980–86, 41.2 in 1987–93, and declined to 18.1 in 1994–2000 ( P < 0.001). These latter rates were 27%, 32% and 47% higher for the three periods, respectively, than rates based on clinical staging at initial diagnosis of prostate cancer. CONCLUSIONS The overall incidence of regional‐distant stages of prostate cancer has declined in recent years, regardless of the stage at initial diagnosis. This may be a result in part of early detection and curative treatments. These findings also indicate that assessing the incidence of regional‐distant prostate cancer only at the initial diagnosis underestimates the full impact of the benefits of early detection and treatment.