Journal of the National Cancer Institute Advance Access originally published online on August 27, 2009
JNCI Journal of the National Cancer Institute 2009 101(18):1280-1283; doi:10.1093/jnci/djp262
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© The Author 2009. Published by Oxford University Press.
BRIEF COMMUNICATION |
Contemporary Risk Profile of Prostate Cancer in the United States
Affiliations of authors: Department of Population Science (Y-HS, KD, CBR, GLL-Y) and Division of Medical Oncology, Department of Medicine (ARM, MNS, RSD) and Department of Biometrics (WS), Cancer Institute of New Jersey, New Brunswick, NJ; Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ (ARM, MNS, RSD, GLL-Y); Department of Epidemiology (KD, GLL-Y) and Department of Biostatistics (WS), School of Public Health, University of Medicine and Dentistry in New Jersey, Piscataway, NJ; The Dean and Betty Gallo Prostate Cancer Center (ARM, MNS, RSD, GLL-Y)
Correspondence to: Grace L. Lu-Yao, PhD, Department of Medicine, University of Medicine and Dentistry of New Jersey, 195 Little Albany St, Rm 5534, New Brunswick, NJ (e-mail:luyaogr{at}umdnj.edu).
National-level data that characterize contemporary prostate cancer patients are limited. We used 2004–2005 data from the Surveillance, Epidemiology, and End Results Program to generate a contemporary profile of prostate cancer patients (N = 82 541) and compared patient characteristics of this 2004–2005 population with those of patients diagnosed in 1998–1989 and 1996–1997. Among newly diagnosed patients in 2004–2005, the majority (94%) had localized (ie, stage T1 or T2) prostate cancer and a median serum prostate-specific antigen (PSA) level of 6.7 ng/mL. Between 1988–1989 and 2004–2005, the average age at prostate cancer diagnosis decreased from 72.2 to 67.2 years, and the incidence rate of T3 or T4 cancer decreased from 52.7 per 100 000 to 7.9 per 100 000 among whites and from 90.9 per 100 000 to 13.3 per 100 000 among blacks. In 2004–2005, compared with whites, blacks were more likely to be diagnosed at a younger age (mean age: 64.7 vs 67.5 years, difference = 2.7 years, 95% confidence interval [CI] = 2.5 to 2.9 years, P < .001) and to have a higher PSA level at diagnosis (median PSA level: 7.4 vs 6.6 ng/mL, difference = 0.8 ng/mL, 95% CI = 0.6 to 1.0 ng/mL, P < .001). In conclusion, more men were diagnosed with prostate cancer at a younger age and earlier stage in 2004–2005 than in earlier years. The racial disparity in cancer stage at diagnosis has decreased statistically significantly over time.
| CONTEXT AND CAVEATS Prior knowledge The increasing number of prostate cancer cases that are diagnosed earlier in the course of disease as a result of prostate-specific antigen testing may change the risk profile of patients with prostate cancer. However, population-based studies of contemporary prostate cancer patients that are representative of the US population are lacking. Study design Surveillance, Epidemiology, and End Results Program data for 2004–2005 were used to generate a contemporary profile of prostate cancer patients and to compare the characteristics of the 2004–2005 patient population with those of patients diagnosed in 1988–1989 and 1996–1997 and with those of participants in a randomized trial of radical prostatectomy vs watchful waiting that showed better survival for patients aged 65 years or younger in the radical prostatectomy group. Contribution Patients diagnosed in 2004–2005 were younger and had earlier stage cancers than patients diagnosed in earlier years. The incidence of stage T3 or T4 cancer at diagnosis has decreased in both blacks and whites and the racial disparity in cancer stage at diagnosis has decreased over time. Compared with patients in the trial, patients in the Surveillance, Epidemiology, and End Results population had a lower prostate-specific antigen level and earlier cancer stage at diagnosis. Implications It remains to be determined whether more patients being diagnosed at earlier stages ultimately results in a decreased mortality and whether the narrowing of the racial disparity in the presentation of advanced prostate cancer is ultimately accompanied by similar trend in mortality. Limitations Changes in prostate-specific antigen level at diagnosis of prostate cancer patients over time could not be directly compared. A more refined classification of Gleason scores before 2004 was not possible. From the Editors
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Manuscript received January 22, 2009; revised July 1, 2009; accepted July 14, 2009.
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J Natl Cancer Inst 2009 101: 1221.
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