Recent trends in prostate cancer testing and incidence among men under age of 50. Cancer Epidemiol

Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA 30341, United States.
Cancer epidemiology 11/2011; 36(2):122-7. DOI: 10.1016/j.canep.2011.10.014
Source: PubMed


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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    • "Although diagnosed more often in older adulthood, or at the median age of 66 years old [6], diagnosis of prostate cancer among younger men has more than doubled over the past two decades [7,8]. Age at the time of diagnosis of prostate cancer is a meaningful factor to consider given the fact that younger men typically live with the consequences of the disease and treatment for a longer amount of time [9]. "

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    • "The increase from 1992 to 2010 in the proportion of survivors who were men was not found in the general population of respondents with no history of cancer. While exact reasons for the gender difference among survivors are unknown, it is possible that this is a result of the trend toward earlier diagnosis and possible over diagnosis of prostate cancer [13] [14]. Furthermore, the increasing proportion of survivors who are Non-Hispanic Black may be attributed to findings showing a continued increase in cancer survival rates of African Americans in the United States [2] [15]. "
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    ABSTRACT: Diagnostic and therapeutic strategies of prostate cancer may largely influenced by patients' age at presentation. This study is aimed to evaluate the characteristics, diagnostic and treatment strategies in prostate cancer patients in our centres. A cross-sectional analytic study of prostate cancer data in two main referral cancer centres, Cipto Mangunkusumo General Hospital and Dharmais National Cancer Centre from 1995-2010, was therefore performed. Patients were divided into 2 sub-populations; below 60 years (younger patients) and 75 years old and above (older patients). PSA levels, diagnostic modalities, Gleason score and therapeutic options were analysed for both and compared using bivariate analysis. 152 patients were <60 years and 210 were ≥75 years. There was no statistical difference in mean PSA level (797.9ng/mL vs 345.3 ng/mL, respectively; p>0.05) and diagnosis was made by biopsy in majority of patients in both groups (68.2% and 71.6% in younger and older groups respectively). Most presented with an advanced disease stage (65.1% and 66.0%, respectively) and there was no statistically significant difference in mean Gleason scores f (8.1 vs 7.7; p>0.05). Primary androgen deprivation therapy (PADT) was the main treatment for overall patients (48.0% and 50.7%, respectively). Radiotherapy and radical prostatectomy are the main therapeutic modalities for younger patients with local and locally advanced disease (39.6% and 35.4% respectively), while the majority of older patients with the same disease stage were treated with radiotherapy and PADT (45.8% and 39.0% respectively). Differences observed in treatment modalities were statistically significant (p<0.0003). We conclude that there is no difference in disease clinical aggressiveness of the two groups but significant differences were obseved in therapeutic strategies utilised with younger and older patients.
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