Temporal Trends in Cause of Death Among Swedish and US Men with Prostate Cancer.

ScD, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, 9th floor, Boston, MA 02115. .
CancerSpectrum Knowledge Environment (Impact Factor: 14.07). 07/2012; 104(17):1335-42. DOI: 10.1093/jnci/djs299
Source: PubMed

ABSTRACT Background A growing proportion of men diagnosed with localized prostate cancer detected through prostate-specific antigen testing are dying from causes other than prostate cancer. Temporal trends in specific causes of death among prostate cancer patients have not been well described. Methods We analyzed causes of death among all incident prostate cancer cases recorded in the nationwide Swedish Cancer Registry (1961-2008; n = 210 112) and in the US Surveillance, Epidemiology, and End Results Program (1973-2008; n = 490 341). We calculated the cumulative incidence of death due to seven selected causes that accounted for more than 80% of the reported deaths (including ischemic heart disease and non-prostate cancer) and analyzed mortality trends by calendar year and age at diagnosis and length of follow-up. Results During follow-up through 2008, prostate cancer accounted for 52% of all reported deaths in Sweden and 30% of reported deaths in the United States among men with prostate cancer; however, only 35% of Swedish men and 16% of US men diagnosed with prostate cancer died from this disease. In both populations, the cumulative incidence of prostate cancer-specific death declined during follow-up, while the cumulative incidences of death from ischemic heart disease and non-prostate cancer remained constant. The 5-year cumulative incidence of death from prostate cancer among all men was 29% in Sweden and 11% in the United States. Conclusions In Sweden and the United States, men diagnosed with prostate cancer are less likely to die from prostate cancer than from another cause. Because many of these other causes of death are preventable through changes in lifestyle, interventions that target lifestyle factors should be integrated into prostate cancer management.

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    ABSTRACT: Purpose To prospectively assess the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) for the detection of significant prostate cancer (PCa). Materials and Methods Prospective study of 111 consecutive men with prostate and/or bladder cancer undergoing 3T DW-MRI of the pelvis without endorectal coil prior to radical prostatectomy (n=78) or cystoprostatectomy (n=33). Three independent readers blinded to clinical and pathological data assigned PCa suspicion grade based on a qualitative DW-MRI analysis. Final pathology of prostates with and without cancer was the reference standard. Primary outcomes were sensitivity and specificity of DW-MRI for detection of significant PCa, defined as largest diameter of the “index lesion” ≥1 cm or extraprostatic extension or Gleason score ≥7 at final pathology. Secondary outcomes were inter-reader agreement assessed with Fleiss’ kappa coefficient, and DW-MRI reading time. Results Of the 111 patients, 93 had PCa (80 significant and 13 insignificant disease) and 18 had no PCa at final pathology. Sensitivity and specificity of DW-MRI for detection of significant PCa ranged from 89% to 91% and 77% to 81%, respectively, for the three readers. Inter-reader agreement was good, with Fleiss’ kappa coefficient ranging from 0.65 to 0.74. Median reading time ranged between 13 min and 18 min. Conclusions 3T DW-MRI is a noninvasive technique that allows for detection of significant PCa with a high probability without contrast medium or endorectal coil, with good inter-reader agreement and in a short reading time. This technique should be further evaluated as a tool to stratify PCa patients for individualized treatment options.
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    ABSTRACT: Background This very large population-based study investigated outcomes after a diagnosis of prostate cancer (PCa) in terms of mortality rates, treatments and adverse effects. Methods Among the 11 million men aged 40 years and over covered by the general national health insurance scheme, those with newly managed PCa in 2009 were followed for two years based on data from the national health insurance information system (SNIIRAM). Patients were identified using hospitalisation diagnoses and specific refunds related to PCa and PCa treatments. Adverse effects of PCa treatments were identified by using hospital diagnoses, specific procedures and drug refunds. Results The age-standardised two-year all-cause mortality rate among the 43,460 men included in the study was 8.4%, twice that of all men aged 40 years and over. Among the 36,734 two-year survivors, 38% had undergone prostatectomy, 36% had been treated by hormone therapy, 29% by radiotherapy, 3% by brachytherapy and 20% were not treated. The frequency of treatment-related adverse effects varied according to age and type of treatment. Among men between 50 and 69 years of age treated by prostatectomy alone, 61% were treated for erectile dysfunction and 24% were treated for urinary disorders. The frequency of treatment for these disorders decreased during the second year compared to the first year (erectile dysfunction: 41% vs 53%, urinary disorders: 9% vs 20%). The frequencies of these treatments among men treated by external beam radiotherapy alone were 7% and 14%, respectively. Among men between 50 and 69 years with treated PCa, 46% received treatments for erectile dysfunction and 22% for urinary disorders. For controls without PCa but treated surgically for benign prostatic hyperplasia, these frequencies were 1.5% and 6.0%, respectively. Conclusions We report high survival rates two years after a diagnosis of PCa, but a high frequency of PCa treatment-related adverse effects. These frequencies remain underestimated, as they are based on treatments for erectile dysfunction and urinary disorders and do not reflect all functional outcomes. These results should help urologists and general practitioners to inform their patients about outcomes at the time of screening and diagnosis, and especially about potential treatment-related adverse effects.
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Mara Meyer Epstein