Risk of dying of prostate cancer really has been decreasing


According to a study published on line last week in the Journal of the National Cancer Institute, not only are men with prostate cancer more likely to die from other conditions, the risk that they will die of prostate cancer (as opposed to other conditions) has been decreasing significantly over time.

The study by Epstein et al. is based on data from > 700,000 men identified in the U.S. Surveillance, Epidemiology, and End Results (SEER) and in the Swedish Cancer and Cause of Death databases. According to the lead researcher (as quoted in an article on the HealthDay web site): “Our study is the first to analyze specific causes of death among men with prostate cancer.”

The databases allowed the research team to look at causes of deaths from 1973 through 2008 for 490,341 men in the USA and from 1961 through 2008 for 210,212 men in Sweden.

The authors were then able to estimate the cumulative incidence of death from seven selected causes accounting for > 80 percent of the reported deaths and also to analyze mortality trends by calendar year and age at diagnosis and length of follow-up.

There primary results are reported as follows:

  • Among all the men in the two databases
    • 52 percent of the men in Sweden died during the 47-year study period.
    • 30 percent of men in the USA died during the 35-year study period.
  • Among men diagnosed with prostate cancer in the two databases
    • 35 percent of Swedish men died from this disease during the study period.
    • 16 percent of American men died from this disease during the study period.
  • The cumulative incidence of prostate cancer-specific death declined during follow-up in both populations.
  • The cumulative incidences of death from ischemic heart disease and from cancers other than prostate cancer remained constant.
  • During the last 5 years of the study period (i.e., from 2003 to 2008),
    • The 5-year cumulative incidence of death from prostate cancer was 29 percent in Sweden.
    • The 5-year cumulative incidence of death from prostate cancer was 11 percent in the USA.

It is also noted that most of the men who died from prostate cancer during the two study periods were men diagnosed when they were older or were diagnosed before the widespread use of the PSA test.

Dr. Epstein is further quoted as stating:

We hope the study will have an impact on the clinical management of men who receive a diagnosis of prostate cancer.

and

We hope it will encourage physicians to use the diagnosis as a teachable moment to encourage men to modify lifestyle factors, like losing weight, increasing physical activity and stopping smoking. We believe that adopting a healthier lifestyle may reduce a man’s risk of other chronic medical conditions that ultimately account for more deaths among men with prostate cancer than the disease itself.

The report on the HealthDay web site also offers statements from Dr. Durado Brooks of the American Cancer Society and from Dr. Louis Kavoussi, chairman of urology at North Shore-Long Island Jewish Health System in New York, with regard to the implications of these data on the need for appropriate use of the PSA test (as opposed to mass, population-based screening). According to Kavoussi:

Prostate cancer does kill and if you pick it up early, it can be treated. The problem with PSA screening is that too many men are treated when they don’t have to be. It’s not bad to detect prostate cancer. The bad thing is that you treat everybody.

He added that:

Many men don’t need to be screened. Those who should be screened are men with a family history of prostate cancer, blacks and anyone else at high risk.

Epstein and her colleagues conclude that, in both the USA and Sweden:

  • Men diagnosed with prostate cancer are less likely to die from prostate cancer than from another cause, and that
  • Because many of these other causes of death are preventable through changes in lifestyle, interventions that target lifestyle factors should be integrated into prostate cancer management.

One Response

  1. There are two ways I look at this article. The first way is whether or not increasing health risk factors (dietary, obesity) have simply raised all-cause death versus that we’re better at treating or discovering the disease sooner.

    The second way I look at it is whether the influx of new diagnoses, and the amount of money put into prostate cancer research is due in large part to ~ prostate cancer screening. Ironic as it sounds, I have always wondered the point of whether we have seen great breakthroughs in treating prostate cancer due in large part to the PSA screening era. A theory that more men being diagnosed brings us more money for treatment and research that we may otherwise have never seen.

    I suspect much of each is involved in reducing the mortality rates in prostate cancer cases. But I also suspect that business thrives best when a market is growing. The PSA test gave the prostate cancer market a huge boost. I don’t think there’s any room to question that. Now the question is, if we reduce the number of men diagnosed each year ~ will the mortality rates maintain their decline?

    One more thought about preventable death ~ it isn’t… :-)

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