Journal of the National Cancer Institute Advance Access originally published online on June 27, 2007
JNCI Journal of the National Cancer Institute 2007 99(13):1052-1053; doi:10.1093/jnci/djm018
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© The Author 2007. Published by Oxford University Press.
CORRESPONDENCE |
Re: Trends in Radical Prostatectomy Rates
Affiliations of authors: SER-Epidemiological Department, Veneto Region, Castelfranco Veneto, Treviso, Italy (UF, NA, PS); Unit of Cancer Epidemiology, S. Giovanni Battista Hospital and University of Turin, Torino, Italy (GC, CG)
Correspondence to: Ugo Fedeli, MD, MSc, SER-Epidemiological Department, Veneto Region. Via Ospedale 18-31033 Castelfranco Veneto (TV), Italy (e-mail: ugo.fedeli{at}ulssasolo.ven.it).
The practice of using serum level of prostate-specific antigen (PSA) to screen for prostate cancer is not yet grounded in evidence pending data from large studies ongoing in United States and Europe (1,2). Nonetheless, the widespread use of PSA testing is associated with a huge increase in prostate cancer incidence in many countries. In Italy, where PSA screening for prostate cancer is not recommended by the National Health Service, the incidence of prostate cancer doubled from 1988–1992 to 1998–2002 (3), indicating the widespread use of opportunistic PSA testing (4).
The increased use of PSA testing paralleled an increase in the practice of radical prostatectomy, a procedure of uncertain effectiveness in screen-detected prostate cancer and with a relative high harm-to-benefit ratio, mainly because of the appreciable risk of impotence and incontinence (5). In the United States, the peak in radical prostatectomy rates was reached in 1992–1993 (40 per 100000 men per year) and coincided with the diffusion of PSA screening; in 1994–1995, rates began to decline in men who were 65 years or older (6). In England, PSA screening was discouraged throughout the 1990s; the use of radical prostatectomy in England increased, but the rate remained far lower than in the United States (<10 per 100000 men in London in 1999) (5). The remarkable difference in radical prostatectomy rates observed between countries reflects the different diffusion of opportunistic PSA screening, as well as the worldwide lack of consensus on the extent to which surgery is preferable to other treatment options, particularly for elderly men.
In Italy, the number of radical prostatectomies more than doubled from 1999 to 2003 (http://www.ministerosalute.it/programmazione/sdo/ric_informazioni/default.jsp). We examined recent data on radical prostatectomy rates from the discharge databases of two regions in Northern Italy (Veneto and Piedmont), each with a male population in 2005 slightly above 2 million. The incidence rate of prostate cancer in these two regions, as reported by the Veneto Cancer Registry and the Cancer Registry of Turin (3), was very similar and increased sharply over time.
In Veneto, age-specific radical prostatectomy rates increased markedly from 1999 through 2004; only in 2005 was a leveling off of the rate observed in men aged 60 years or older (Fig. 1). In 2005, a record rate of 465 procedures per 100000 men aged 65–69 years was reached, a value similar to the peak observed in the United States in the early 1990s (6). Data from Piedmont showed a similar increase in radical prostatectomy, although the rates remained lower than those observed in the Veneto region throughout the observation period (Fig. 1).
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The increase in radical prostatectomy rates in both regions indicates that the Italian scenario is now similar to that in United States more than 10 years ago, even though there is still no convincing evidence of the effectiveness of screening or a consensus about the optimal treatment of localized disease (1). The differences in rates between the two regions in Italy suggest discrepancies in urologic practice, even between two areas of the same country with a similar standard of living.
Current uncertainties regarding the efficacy of prostate cancer treatment should stimulate a strict epidemiologic surveillance of radical prostatectomy, as well as of other therapeutic options, including radiotherapy and androgen suppression.
REFERENCES
(1) National Cancer Institute. Prostate cancer: screening and testing; treatment. Available at: http://www.cancer.gov/cancertopics. [Last accessed: May 29, 2007.].
(2) Church TR. Prostate-specific antigen and prostate cancer prognosis. In: J Natl Cancer Inst (2006) 98:1509–10.
(3) AIRT Working Group. Italian cancer figures—report 2006. Epidemiol Prev (2006) 30(Suppl 2):8–10. 12–28, 30–101 passim. Available at: http://www.registri-tumori.it/incidenza1998-2002/gruppi.html. [Last accessed: May 29, 2007.].[Medline]
(4) D'Ambrosio G, Samani F, Cancian M, De Mola C. Practice of opportunistic prostate-specific antigen screening in Italy: data from the Health Search database. Eur J Cancer Prev (2004) 13:383–6.[CrossRef][Web of Science][Medline]
(5) Oliver SE, Donovan JL, Peters TJ, Frankel S, Hamdy FC, Neal DE. Recent trends in the use of radical prostatectomy in England: the epidemiology of diffusion. BJU Int (2003) 91:331–6.[CrossRef][Web of Science][Medline]
(6) Wingo PA, Guest JL, McGinnis L, Miller DS, Rodriguez C, Cardinez CJ, et al. Patterns of inpatient surgeries for the top four cancers in the United States, National Hospital Discharge Survey, 1988–95. Cancer Causes Control (2000) 11:497–512.[CrossRef][Web of Science][Medline]
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