Changes in incidence, survival and mortality of prostate cancer in Europe and the United States in the PSA era: additional diagnoses and avoided deaths
ABSTRACT We describe changes in prostate cancer incidence, survival and mortality and the resulting impact in additional diagnoses and avoided deaths in European areas and the United States.
Using data from 12 European cancer registries and the Surveillance, Epidemiology and End Results program, we describe changes in prostate cancer epidemiology between the beginning of the PSA era (USA: 1985-1989, Europe: 1990-1994) and 2002-2006 among patients aged 40-64, 65-74, and 75+. Additionally, we examine changes in yearly numbers of diagnoses and deaths and variation in male life expectancy.
Incidence and survival, particularly among patients aged <75, increased dramatically, yet both remain (with few exceptions in incidence) lower in Europe than in the United States. Mortality reductions, ongoing since the mid/late 1990 s, were more consistent in the United States, had a distressingly small absolute impact among patients aged 40-64 and the largest absolute impact among those aged 75+. Overall ratios of additional diagnoses/avoided deaths varied between 3.6 and 27.6, suggesting large differences in the actual impact of prostate cancer incidence and mortality changes. Ten years of remaining life expectancy was reached between 68 and 76 years.
Policies reflecting variation in population life expectancy, testing preferences, decision aids and guidelines for surveillance-based management are urgently needed.
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ABSTRACT: Background: Information on the current and future numbers of Australian men living with prostate cancer is limited. We describe a method for estimating complete prevalence of prostate cancer to provide a measure of the burden of prostate cancer in Australia. Methods: Prostate cancer data from the New South Wales (NSW) Central Cancer Registry were used with PIAMOD (Prevalence and Incidence Analysis MODel) software to estimate future prostate cancer prevalence in NSW. We first fitted parametric incidence and survival models then used the modelled incidence and survival estimates to calculate complete prevalence. The estimated and projected prevalence incorporate past observed trends and take into account different assumptions about future survival trends. These models were validated against observed prevalence from the counting method. Results: Based on data for 1996–2007, the number of men living with prostate cancer in NSW was estimated to rise by 59% to 73%, from 38,322 in 2007 to 60,910–66,160 in 2017. The increasing incidence rates and the ageing population were the major contributors to this estimated increase. Validation suggested that these projections were reasonable, as the estimated prevalence in 1996–2007 was in good agreement with the corresponding prevalence calculated using the direct counting method, and the incidence models were supported by the recent data on prostate-specific antigen testing. Conclusions: As the number of men living with prostate cancer is expected to increase dramatically in the next decade in Australia, representing a significant challenge to the health system, careful planning and development of a healthcare system able to respond to this increased demand is required. These projections are useful for addressing the challenge in meeting the cancer care needs of men with prostate cancer.Cancer Epidemiology 12/2014; 39(1). DOI:10.1016/j.canep.2014.11.009
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ABSTRACT: Radical external-beam radiotherapy (EBRT) is a standard treatment for prostate cancer (PC) patients. Despite this, the rate of intraprostatic relapses after primary EBRT is still not negligible. There is no consensus on the most appropriate management of these patients after EBRT failure. Treatment strategies after PC relapse are strongly influenced by the effective site of the tumor recurrence, and thus the instrumental evaluation with different imaging techniques becomes crucial. In cases of demonstrated intraprostatic failure, several systemic (androgen deprivation therapy) or local (salvage prostatectomy, cryotherapy, high-intensity focused ultrasound, brachytherapy, stereotactic EBRT) treatment options could be proposed and are currently delivered by clinicians with a variety of results. In this review we analyze the correct definition of intraprostatic relapse after radiotherapy, focusing on the recent developments in imaging to detect intraprostatic recurrence. Furthermore, all available salvage treatment options after a radiation therapy local failure are presented and thoroughly discussed.Critical reviews in oncology/hematology 08/2013; DOI:10.1016/j.critrevonc.2013.07.009
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ABSTRACT: Photodynamic therapy (PDT) can be employed as a focal therapy for prostate cancer. Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) can potentially help identify tumour recurrence after failed external-beam radiotherapy (EBRT). The purpose of this study was to determine the ability of DCE-MRI to predict early response to PDT salvage treatment. Patients with post-EBRT prostate cancer recurrence were prospectively enrolled into a Phase I/II trial of PDT using WST09. A 15-patient subgroup of this cohort undergoing 1.5T DCE-MRI at baseline and 1-week post-PDT was retrospectively analyzed. The reference standard was prostate biopsy obtained 6 months post-PDT. Analysis was performed on a patient-by-patient basis, by prostate gland halves, and by prostate sextants. Biopsy 6 months post-PDT identified cancer in 10/15 patients (66.7%), and in 24/90 sextants (26.7%). Residual cancer was identified in 22/37 sextants (59.5%) identified as being involved at baseline. DCE-MRI at 1 week correctly predicted recurrent disease with a sensitivity of 100% (10/10), specificity of 60% (3/5), positive predictive value of 83.3% (10/12), negative predictive value of 100% (3/3), and an overall accuracy of 86.7%, (13/15). When analysis was performed on prostate halves, the sensitivity and negative predictive value remained at 100%, with an improvement in specificity to 88.2% (15/17). The overall accuracy of DCE-MRI was similar regardless of analysis method: 86.7% on a patient-by-patient basis, 86.7% by prostate half and 83.3% by sextant. Changes in prostate-specific antigen (PSA) did not correlate to response. DCE-MRI shows promise as a tool to predict successful outcome when performed 1 week post-PDT and could potentially be used to inform the need for re-treatment at an early time-point.10/2014; 8(9-10):E708-E714. DOI:10.5489/cuaj.2176