Recent trends in prostate cancer testing and incidence among men under age of 50
ABSTRACT Information on prostate cancer testing and incidence among men under age 50 is scant. This study aims to describe trends of prostate cancer testing and incidence by demographic and clinical characteristics and identify potential correlations between prostate cancer testing and incidence.
We examined prostate cancer testing and incidence rates among American men under age of 50 using data from the Behavioral Risk Factor Surveillance System (2002, 2004, 2006, and 2008) and data from the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results programs (2001-2006). We conducted descriptive, logistic regression, and trend analyses using SUDAAN and SEER*Stat.
The prostate cancer incidence rate among black men was more than 2-fold that of white men. The overall prostate cancer incidence rate slightly increased from 2001 to 2006; however, the prevalence of prostate cancer testing declined over time. There was a borderline significant increase in prostate cancer incidence rate (APC=3.5, 95% CI=0.0, 7.0) for men aged 40-44. Well-differentiated prostate cancer incidence decreased significantly (APC=-24.7; 95% confidence interval (CI)=-34.9, -12.8) over time.
We observed a large difference in prostate cancer incidence between blacks and whites under age 50. Similar patterns in prostate cancer testing and cancer incidence by race and ethnicity suggested prostate cancer testing might have influenced incidence to some extent in this young population. The different temporal patterns for prostate cancer testing and incidence, especially for men aged 40-44 years, suggested screening alone could not fully accounted for the increasing prostate cancer incidence rates. Decreasing trend of well-differentiated prostate cancer may be partially due to "Grade Inflation".
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ABSTRACT: Prostate cancer (PCa) screening has been substantially influenced by the clinical implementation of serum prostate-specific antigen (PSA). In this context, improvement of early PCa detection and stage migration as well as reduced PCa mortality were achieved, and up-to-date PSA represents the gold standard biomarker of PCa diagnosis together with clinical findings. Nonetheless, PSA shows weakness in discriminating between malign and benign prostatic disease or indolent and aggressive cancers. As a result, the expansion of PSA screening is extensively debated with regard to overdetection and ultimately overtreatment, keeping in mind that PCa is still the third leading cause of cancer-specific mortality in the Western male population. Consequently, today's task is to increase the accuracy of PCa detection and furthermore to allow stratification for indolent PCa that might permit active surveillance and to filter out aggressive cancers necessitating treatment. Thus, novel biomarkers, especially in combination with approved clinical risk factors (e.g., age or family history of PCa), within multivariable prediction models carry the potential to improve many aspects of PCa diagnosis and to enable risk classification in clinical practice. Multivariable models lead to superior accuracy for PCa prediction instead of the use of a single risk factor. The aim of this article was to present an overview of known risk factors for PCa together with new promising blood- and urine-based biomarkers and their application within risk models that may allow risk stratification for PCa prior to prostate biopsy. Risk models may optimize PCa detection and classification with regard to improved PCa risk assessment and avoidance of unnecessary prostate biopsies.World Journal of Urology 05/2014; 32(4). DOI:10.1007/s00345-014-1317-2 · 3.42 Impact Factor
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ABSTRACT: To addressed the biochemical and functional outcomes after radical prostatectomy (RP) of men <50 years of age in a large European population. Among 13268 patients who underwent RP for clinically localized prostate cancer (PCa) at our centre (1992-2011), 443 (3.3%) men <50 years of age were identified. Biochemical recurrence (BCR) and functional outcomes (International Index of Erectile Function (IIEF-5), use of pads), were prospectively evaluated and compared between men < 50 and older patients. Men <50 were more likely to harbour D'Amico low-risk (49.4 vs. 34.9%, p<0.001), organ-confined (82.6 vs. 69.4%, p<0.0001) and low-grade tumors (Gleason score (GS) <7: 33.1 vs. 28.7%, p<0.001). Multivariate Cox regression analysis revealed that age <50 (HR: 0.99; CI: 0.72-1.31; P=0.9) represented no predictor of BCR. Urinary continence was more favorable in younger patients, resulting in continence rates of 97.4 vs. 91.6% in most recent years (2009-2011) for patients <50 vs. ≥50 years of age. Postoperatively, a median IIEF-5 drop of 4 points in younger men vs. 8 points in older patients was recorded (<0.001). Favorable recovery of urinary continence and erectile function in patients younger than 50 years of age compared to their older counterparts was confirmed after multivariable adjustment. Men <50 years diagnosed with localized PCa should not be discouraged from RP as the postoperative rates of urinary incontinence and erectile dysfunction are low and probability of BCR-free survival at 2 and 5-yrs is high.BJU International 08/2013; 114(1). DOI:10.1111/bju.12407 · 3.13 Impact Factor
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ABSTRACT: Age-adjusted mortality rates for prostate cancer are higher for African-American men compared with those of European ancestry. Recent data suggest that West African men also have elevated risk for prostate cancer relative to European men. Genetic susceptibility to prostate cancer could account for part of this difference. We conducted a genome-wide association study (GWAS) of prostate cancer in West African men in the Ghana Prostate Study. Association testing was performed using multivariable logistic regression adjusted for age and genetic ancestry for 474 prostate cancer cases and 458 population-based controls on the Illumina HumanOmni-5 Quad BeadChip. The most promising association was at 10p14 within an intron of a long non-coding RNA (lncRNA RP11-543F8.2) 360 kb centromeric of GATA3 (p = 1.29E-7). In sub-analyses, SNPs at 5q31.3 were associated with high Gleason score (≥7) cancers, the strongest of which was a missense SNP in PCDHA1 (rs34575154, p = 3.66E-8), and SNPs at Xq28 (rs985081, p = 8.66E-9) and 6q21 (rs2185710, p = 5.95E-8) were associated with low Gleason score (<7) cancers. We sought to validate our findings in silico in the African Ancestry Prostate Cancer GWAS Consortium, but only one SNP, at 10p14, replicated at p < 0.05. Of the 90 prostate cancer loci reported from studies of men of European, Asian or African-American ancestry, we were able to test 81 in the Ghana Prostate Study, and 10 of these replicated at p < 0.05. Further genetic studies of prostate cancer in West African men are needed to confirm our promising susceptibility loci.Human Genetics 11/2013; 133(5). DOI:10.1007/s00439-013-1400-6 · 4.52 Impact Factor