Higher-Risk Prostate Cancer On the Rise

Due to the resulting change in prognosis with low versus higher-risk disease, the investigators predict that at least 1,400 more men may die from PCa each year.
Due to the resulting change in prognosis with low versus higher-risk disease, the investigators predict that at least 1,400 more men may die from PCa each year.

ORLANDO, Fla.—Intermediate- or high-risk prostate cancer (PCa) cases may be increasing in the United States, according to a new study presented at the 2015 Genitourinary Cancers Symposium.

Timothy E. Schultheiss, PhD, director of radiation physics at City of Hope in Duarte, Calif., and colleagues analyzed data from 87,562 men diagnosed with PCa from January 2005 to June 2013. The researchers categorized patients with localized PCa into risk groups using National Comprehensive Cancer Network (NCCN) criteria, with intermediate risk defined as T2b-T2c and/or Gleason score 7 and/or PSA 10-20 ng/mL, and high risk as T3 or Gleason score 8-10 or PSA greater than 20 ng/mL.

From 2005 to 2011, the proportion of men with PCa and PSA greater than 10 ng/mL decreased, but the proportion increased by a significant 3% per year from 2011 to 2013. From 2011 to 2013, the percentage of men aged 75 years and older presenting with a PSA level above 10 ng/mL increased by nearly double the rate for men of all ages. The investigators observed no significant trends in Gleason score.

Prior to 2011—when the U.S. Preventive Services Task Force (USPSTF) issued a document recommending against PSA screening regardless of a man's age—the proportion of men with intermediate or high-risk PCa remained stable at 70%–73%.

Based on an estimated 233,000 new PCa cases in 2014, the researchers estimated that approximately 14,000 men per year will shift from a low risk into a higher-risk disease group. Due to the resulting change in prognosis with low versus higher-risk disease, the investigators predict that at least 1,400 more men may die from PCa each year.

Dr. Schultheiss said the study is the first to measure changes in PCa presentation in the period following release of the 2011 USPTF recommendations. “Given the rise in intermediate- and high-risk prostate cancers seen in our analysis during this timeframe, men who are at increased risk for prostate cancer, especially those with a family history of prostate cancer, should consider talking with their doctor about PSA screening,” he said.

For the study, Dr. Schultheiss' team used data from the National Oncology Data Alliance, a proprietary database of merged tumor registries that captures newly diagnosed cancer cases at more than 150 hospitals in the United States.

“This study, while preliminary, adds new insight to the ongoing debate on the risks and benefits of PSA screening for prostate cancer,” said Charles J. Ryan, MD, speaking on behalf of the American Society of Clinical Oncology, which sponsors the annual symposium. “These findings alone do not warrant changes in physician practice, but they do suggest that men should continue to be encouraged to talk with their doctors about screening to decide whether it is appropriate for them,” said Dr. Ryan, professor of clinical medicine and urology at the University of California San Francisco.

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