Prostate cancer in Italy before and during the 'PSA era': survival trend and prognostic determinants.
ABSTRACT The aim of the study was to investigate the variations in prostate cancer prognosis during a period of major diagnostic change, such as the introduction of the prostate-specific antigen (PSA) test. Data were provided by 14 Italian cancer registries (CRs). Incidence and follow-up information was collected for patients diagnosed from 1978 to 1994. Relative survival was computed taking into account incidence period, age, tumour stage and grade at diagnosis. A multivariate analysis was carried out to evaluate the independent simultaneous effect on survival of some prognostic determinants. A large geographical variability was observed: in 1993-1994 Italian survival rates ranged from 76% to 52%, with a north-south gradient. A striking prognostic improvement (up to +27 percentage points) between the late 1980s and the early 1990s occurred in almost all CRs, particularly with regard to younger patients. Multivariate analysis showed a strong influence of incidence period on survival, also after correction by tumour stage. The slowdown of metastatic cancers suggests that the survival improvement could be due both to the introduction of an effective opportunistic screening and to a quantitative change in the application of clinical treatment, even if the effect of the lead-time bias phenomenon has to be taken into account.
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ABSTRACT: A computer program package has been constructed for use in patient survival analyses for chronic diseases based on aggregated data. The central concept of the analyses--the relative survival rate--is the ratio of the observed survival rate of the patients to the survival rate expected in a group in the general population similar to the group of patients at the beginning of the follow-up (interval), with respect to age, sex and calendar time. This quantity is used to measure patient survival adjusted for the effect of mortality attributable to the competing risks of death without employing information on causes of death of individual patients. The package contains three alternative methods of estimating the relative survival rates, two different ways of estimating the expectation of life for the patients, and five methods of testing the relative survival patterns using information on the whole follow-up period. Conventional survival and competing risk analysis can also be performed with the package. It is hoped that the package will facilitate standardization of statistical methodology and terminology in long-term survival studies for chronic diseases.Computer Programs in Biomedicine 02/1985; 19(2-3):197-207.
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ABSTRACT: The purpose of this review is to examine the implications of recent trends in prostate cancer incidence and mortality and to consider recent progress of epidemiological research on this disease. The incidence and mortality rates for prostate cancer are changing throughout the world at an accelerating pace. Much of the increase in incidence is related to changes in detection technology, but increases in mortality rates suggest other factors are involved. Recent research has focused on race-related difference, diet and related lifestyle exposures, the aetiologic significance of vasectomy and, patterns of familial aggregation. Continued monitoring of trends in incidence and mortality will be important as prostate cancer becomes a greater public health burden worldwide. Epidemiological research has identified several possible risk factors which may be useful for prostate cancer prevention and targeting high-risk individuals for early detection intervention. Additional research may confirm and refine understanding of prostate cancer aetiology.European Journal of Cancer 04/1997; 33(3):340-7. · 5.06 Impact Factor
Article: Mortality in prostate cancer.[show abstract] [hide abstract]
ABSTRACT: We evaluated in patients with prostate cancer whether treatment is associated with in decreased mortality and whether the association of treatment with mortality varies with calendar time. Using the 146,979 prostate cancer patients from the 1973 to 1990 public use tape of the Surveillance, Epidemiology and End Results program, we performed survival analysis and multivariate proportional hazards modeling to estimate the relative risk of disease specific and overall mortality. In men with prostate cancer, advanced age, black race, high tumor stage and not having treatment were independently associated with disease specific and overall mortality. The relative risk of mortality in treated patients decreased significantly from 1973 to 1990. The fact that advanced age and black race are associated with disease specific mortality (even when treatment and stage are controlled) is a new observation, which suggests that tumor biology and/or response to treatment is worse in elderly and black men. Overall, the data are consistent with the hypothesis that treatment of prostate cancer is associated with lower disease specific and overall mortality rates. The decreases in relative mortality in treated patients from 1973 to 1990 indirectly support the theory that changes in patterns of care from 1973 to 1990 had a beneficial effect on mortality. This observation implies that future studies should account for calendar time when interpreting outcomes data.The Journal of Urology 10/1996; 156(3):1084-91. · 3.70 Impact Factor