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. 2012 Dec 1;118(23):5955-63.
doi: 10.1002/cncr.27594. Epub 2012 May 17.

The prostate cancer conundrum revisited: treatment changes and prostate cancer mortality declines

Ruth Etzioni  1 , Roman Gulati, Alex Tsodikov, Elisabeth M Wever, David F Penson, Eveline A M Heijnsdijk, Jeffrey Katcher, Gerrit Draisma, Eric J Feuer, Harry J de Koning, Angela B Mariotto
Affiliations

The prostate cancer conundrum revisited: treatment changes and prostate cancer mortality declines

Ruth Etzioni et al. Cancer. .

Abstract

Background: Prostate cancer mortality rates in the United States declined by >40% between 1991 and 2005. The impact of changes in primary treatment and adjuvant and neoadjuvant hormone therapy on this decline is unknown.

Methods: The authors applied 3 independently developed models of prostate cancer natural history and disease detection under common assumptions about treatment patterns, treatment efficacy, and survival in the population. Primary treatment patterns were derived from the Surveillance, Epidemiology, and End Results registry; data on the frequency of hormone therapy were obtained from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database; and treatment efficacy was based on estimates from randomized trials and comparative effectiveness studies of treatment alternatives. The models projected prostate cancer mortality without prostate-specific antigen screening and in the presence and absence of treatment benefit. The impact of primary treatment was expressed as a fraction of the difference between observed mortality and projected mortality in the absence of treatment benefit.

Results: The 3 models projected that changes in treatment explained 22% to 33% of the mortality decline by 2005. These contributions were accounted for mostly by surgery and radiation therapy, which increased in frequency until the 1990s, whereas hormone therapies contributed little to the mortality decline by 2005. Assuming that treatment benefit was less for older men, changes in treatment explained only 16% to 23% of the mortality decline by 2005.

Conclusions: Changes in primary treatment explained a minority of the observed decline in prostate cancer mortality. The remainder of the decline probably was because of other interventions, such as prostate-specific antigen screening and advances in the treatment of recurrent and progressive disease.

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Figures

Figure 1
Figure 1
Primary treatment dissemination patterns in the US. Footnote to Figure 1. RP is radical prostatectomy and is defined by SEER codes 50, 58, 60, and 68 prior to 1997 and 50 and 70 beginning in 1998. RT is radiation therapy and is defined by SEER categories beam radiation, radioactive implants, radioisotopes, combination of beam with implants or isotopes, or radiation with method or source unspecified. ADT is androgen deprivation therapy from CaPSURE.
Figure 2
Figure 2
Age-adjusted SEER (black) and CISNET model-projected prostate cancer incidence in the presence (solid grays) and absence (dashed grays) of PSA screening.
Figure 3
Figure 3
Age-adjusted SEER (black line) and CISNET model-projected (gray lines) prostate cancer mortality among cases diagnosed from January 1, 1975, under no primary treatment benefit or a combination of primary treatments. Model projections are based on assumption set 1. For comparison, the figure also shows SEER prostate cancer mortality among all cases.
See this image and copyright information in PMC

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References

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