Incidence of diagnosis of prostate cancer declines from 2007 to 2009 in USA

According to a brief research letter by Howard, just published in Archives of Internal Medicine, the incidence of prostate cancer diagnosis in men of ≥ 75 years declined significantly after the issuance of the 2008 recommendation by the USPSTF that PSA screening for prostate cancer was not appropriate in men of 75 years and older.

The full text of this article is available on line, and so is a commentary on this research letter that appears on the MedPage Today web site.

Basically, through analysis of the most recently available SEER data, Howard shows that, between 2007 and 2009, for men ≥ 75 years:

  • The adjusted incidence rate for early-stage prostate cancer tumors dropped by 25.4 percent (from 443/100,000 to 330/100 000)
  • The absolute number of cases of early-stage prostate cancer dropped from 8,137 to 6,162.
  • The adjusted incidence rate for late-stage tumors dropped by 14.3 percent (from 83/100,000 to 71/100,000).
  • The adjusted incidence rate for tumors of unknown stage dropped by 16.8 percent (from 124/100,000 to 103/100,000).

For comparative purposes, Howard also reports that, over the same time frame:

  • The adjusted incidence rate for early-stage tumors among men aged 65 to 74 years dropped by 15.2 percent (from 697/100,000 to 591/100,000).
  • The adjusted incidence rate for early-stage tumors among men aged 30 to 64 years dropped by 11 percent (from 105/100,000 to 93/100,000).

The “New” Prostate Cancer InfoLink wishes to be extremely clear that we have no good information to help us know whether this is a good thing (because it means we aren’t over-biopsying men who will never have clinically significant prostate cancer) or a bad thing (because we are consequently under-diagnosing clinically significant prostate cancer in men of 75 years and older who will consequently get metastatic disease and may die from this).

We do appreciate that among those who believe that any number of deaths from prostate cancer represents failure, this information may be distressing.


2 Responses

  1. I have understood until now that:

    (1) There has been a consistent decline in prostate cancer incidence in the USA since the high in the early 1980s.

    (2) That the number of late-stage diagnoses had also declined.

    Does this change those understandings significantly?

  2. Terry:

    The age-adjusted, SEER-based incidence rate for prostate cancer in the USA was actually highest in the early 1990s (see this graph). At the moment I am not sure what to make of the paper discussed above.

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