Metastatic Prostate Cancer at Diagnosis in Decline
Study documents a drop in the incidence of de novo metastatic PCa from 1980 to 2011 in the United States.
Early detection of prostate cancer (PCa) in the United States has resulted in a decrease in the number of men presenting with metastatic PCa, investigators concluded in a presentation of study findings at the 33rd European Association of Urology Congress in Copenhagen, Denmark.
In an analysis of data from the Surveillance, Epidemiology and End Results (SEER) program, Thomas Helgstrand, MD, PhD, of the Copenhagen Prostate Cancer Center, and colleagues found that the incidence of de novo metastatic PCa declined from 12.0 cases per 100,000 men in 1980–1984 to 4.4 cases per 100,000 men in 2005–2011. The 5-year PCa-specific mortality rate for the entire cohort was 56.5%. It increased from 54.2% in 1980–1984 to 61% in 2005–2009. The decreasing incidence of de novo metastatic PCa was followed by a decrease in overall PCa-specific mortality within 3 years, the investigators reported.
Dr Helgstrand's team compared the SEER findings with those from a cohort of men in Denmark using the Danish Prostate Cancer Registry (DaPCaR). In contrast to SEER results, the incidence of de novo metastatic PCa in the DaPCaR revealed an increase from 6.7 cases per 100,000 men in 1995–1999 to 9.9 per 100,000 in 2005–2011. The 5-year PCa-specific mortality rate for the entire cohort was 64%. The rate decreased significantly from 73.4% in 1995–1999 to 56.8% in 2005–2009. This decrease was accompanied by a non-significant decrease in median age from 74.2 to 73.2 years and a significant decrease in median PSA levels from 320 to 145 ng/mL at diagnosis.
The results from this population-based analysis indicate that early detection identifies patients with PCa at an earlier time in the course of the disease and to an increasing extent before patients have developed metastatic disease, Dr Helgstrand told Renal & Urology News. “An unwanted consequence of this earlier detection, however, is overdiagnosis and overtreatment of men harboring non-lethal localized prostate cancer whose remaining length of life would be unchanged and whose quality of life would possibly would be greater if not diagnosed at all.”
He also observed: “Our findings from the US population suggest that prostate cancer-specific mortality is highly affected by the incidence of de novo metastatic disease. If the patterns of incidence continue to mimic the American [data], a drop in prostate cancer-specific mortality might be anticipated in Denmark within a few years.”
Using the SEER database, Dr Helgstrand's team identified 426,266 men diagnosed with PCa from 1980 to 2011. Using the DaPCaR, they identified 47,024 men diagnosed with PCa from 1995 to 2011. Of these, 29,555 from SEER and 6,874 from DaPCaR were diagnosed with de novo metastatic PCa.
Helgstrand JT, Klemann N, Toft BF, et al. Incidence- and survival trends of de-novo metastatic prostate cancer: A population based analysis of two national cohorts from USA and Denmark. Data presented at the 33rd European Association of Urology Congress in Copenhagen, Denmark.