The American Cancer Society (ACS) has just announced its annual projections for cancer incidence and mortality rates for 2018.
According to its most recent analysis of the available data (see Siegal et al.), during 2018
- 164,690 men in the US will be diagnosed with prostate cancer.
- 29,430 men in the US will die of prostate cancer.
- Prostate cancer remains the most common form of prostate cancer diagnosed in males (at 19 percent of all new cancer cases in men).
- Prostate cancer remains the second most common cancer-related cause of death in men (at 9% of all cancer-specific deaths in males).
In other words,
- The incidence of men being diagnosed with prostate cancer continues to fall since it peaked in about 1992 (see Figure 3 in the paper by Siegal et al).
- The prostate cancer mortality rate has also fallen since it peaked in the mid-1990s, and is now back to where it was in about 1930 (see Figure 7 of the paper by Siegal et al.).
Exactly what these data “mean” when seen over time like this is open to discussion for all sorts of reasons. However, your sitemaster’s general interpretation of the most recent data is that they continue to show us that, although we may have been able to extend the survival of men with more aggressive forms of prostate cancer, we have still made only limited progress in lowering the overall, prostate cancer-specific mortality rate over the past 80 or so years, when that mortality rate is measured in terms of deaths per 100,000 population.
In assessing these data it is very important to distinguish between the absolute numbers of men diagnosed with and dying from prostate cancer each year and the incidence and mortality rates per 100,000 population. After all, the number of men living in America in 1930 was of the order of 62 million, whereas today it is about 162 million, and life expectancy was a lot shorted in 1930 than it is today!
Filed under: Diagnosis, Risk | Tagged: incidence, mortality, risk |
THE "NEW" PROSTATE CANCER INFOLINK 
Continuing Encouraging Trend in Prostate Cancer Survival Statistics!
Thank you for reporting this news that broke today!
It’s hard to improve on better than 99% 5-year survival for all diagnosed men who did not have distant metastases at diagnosis, as documented in this report. Similarly, the 98% for 10-year survival for all diagnosed men is so impressive!
Survival for men diagnosed with distant metastases continues to be the area where progress is still small: 5-year survival was 28% in the 2012 report, remaining stable for several years, but increasing to 29% in the 2017 report, and continuing to increase to 30% in today’s 2018 report. However, the data cut-off is the end of 2015, and some key newer drugs had only been approved for a short time by then, with doctors still learning how to use them (e.g., Zytiga approved in 2011, Xtandi in 2012, Xofigo in 2013). It is reasonable to expect that survival in this group of men who are diagnosed with distant metastases will continue to improve as the newer drugs are more widely and better used.
I have not been able to find 15-year survival numbers yet. The reported number for cases of all kinds at diagnosis (local, regional, distant) was 96% survival in the 2017 report (data through 2014). Again, that figure is monumentally impressive!
Regarding the trend per 100,000 over the decades, I find great encouragement. In the 1930s men typically did not live long enough for prostate cancer to develop and kill. In subsequent decades that changed, with much more opportunity for the disease to affect mortality rates. In other words, were it not for great progress, I suspect the mortality rate per 100,000 men as of 2015 (the data cut-off) would be far higher than it was 80 years ago. It would be helpful if someone would do a statistical analysis of that, but I doubt it is in the ACS report or supplemental statistics.
So let me get this straight … In 2005 according to SEER there were 232,000 new cases of prostate cancer and 30,000 deaths due to prostate cancer.
In 2018 they estimate 165,000 new cases of prostate cancer and 29,000 deaths.
I see absolutely no progress whatsoever. … You can slice the number of new cases however you want … death rate seems worse … a lot worse or at best absolutely no progress in preventing mortality at all. … I don’t know, maybe I’m crazy but in the 10 years since my radical prostatectomy I’ve really seen nothing of meaningful progress in treatments. Just more expensive ones.
Dear Chris:
The vast majority of men who got diagnosed with prostate cancer in 2005 (> 95%) lived for at least 10 years before they died of anything. You can’t just divide the number diagnosed in a specific year by the number dying that yea. The statistics are far more complex than that.
However, Jim is correct when he points out that the problem is men who get diagnosed with very aggressive or already metastatic prostate cancer. The mortality rates for these patients ( a relatively small subset of the total) have changed relatively little over the past 30 years.
My point was the number of people dying from prostate cancer has not changed … and, as you pointed out, advanced prostate cancer deaths haven’t changed either. When it comes down to it, … no progress in the fight has been made.
More on Very Short Time for Recent Drugs to Be Impacting These New ACS Statistics
In addition to the issue of learning curve for physicians, which I mentioned above, there is a more important problem that without doubt negatively affected the ability of recent drugs – Zytiga® (abiraterone), Xtandi® (enzalutamide), and Xofigo (radium 223 dichloride) being the examples I looked at, but with several other new drugs also valuable – to decrease mortality rates for men diagnosed with distant metastases.
As noted above, the cut off for the statistics published yesterday was the end of 2015, and the drugs were approved on April 28, 2011 (Zytiga®), August 31, 2012 (Xtandi®), and May 15, 2013 (Xofigo®). Thus, the numbers of months for each of the drugs to go to eligible patients prior to the end of the 2015 data cut-off for the ACS report were 56 months (Zytiga®), 40 months (Xtandi®), and 32 months (Xofigo®).
Here is the key factor preventing much impact by the end of 2015 of these new drugs. Eligibility barriers included requirements for Zytiga® and Xtandi® that men be castrate resistant and recipients of prior docetaxel therapy. The requirement for Xofigo® was that they be castrate resistant, have symptomatic bone metastases, and no known visceral metastases.
Now we know that androgen deprivation therapy (aka hormonal therapy) works well in metastatic patients for a period, generally expected to be in the range of 18 to 24 months for such men (and far longer for others), at which point it no longer controls the cancer, and the patients are considered “castrate resistant.” At that point, especially up through 2015, a course of chemotherapy would often be employed, and that would be effective for a period, perhaps a year to 18 months (could use some help here) before another agent would be desired to control the cancer. Therefore, adding both the period for ADT and the subsequent period for chemo, we have a period of roughly 3 years — 36 months — in the 2015 era before patients would have been eligible in 2015 for Zytiga® and Xtandi®, and around 2 years — 24 months for Xofigo (shorter because prior chemo was not a requirement). That means that by the end of 2015 few patients would have even been eligible for these new drugs, even if the drug suppliers, insurers, medical associations, and ultimately doctors would have had access and knowledge needed to employ them.
With this realization, it is reasonable to expect substantially improving survival in the next few years for men diagnosed with distant metastases.
When I read all of this stuff, I feel that my husband is at Defcom 5 right now.
He was diagnosed November 2012 with Stage IV metastatic prostate cancer (Gleason score of 10; PSA well over 100; all 12 quadrants biopsied positive for cancer — a few at 75%, most at 100%). He has had every known chemo to fight this (Xtandi; Zytiga; doxetaxel; cabazitaxel). He has also had Provenge, along with 40 rounds of radiation + firmagon as the first treatments. He still receives Lupron every 6 months, and for a while it was holding the cancer at bay a little. However, this time, his PSA continues to rise around 10+ points per month.
I realize that we are blessed and I am thankful that he is still with us 5+ years after diagnosis. He was recently diagnosed with Lewy body dementia — and while I totally agree with the dementia part — not so sure about the Lewy body since I took him off of the olanzapine since he was not ever psychotic or anything like that and it had turned him into a zombie. Doctors agreed with me — someone in the hospital put him on this … — suffice to say, his mental faculties are much better now. However, this does not address the cancer itself.
Will there be anything new within the next year or sooner that we can try to beat this cancer or at least hold it at bay for another few years without causing him to have a bad quality of life?
I want him to be OK. I’d prefer a total cure — but if that can’t happen without a miracle, is there anything in the works? What about the CAR-T I keep reading about?
Dear Ellen:
I think I have said this before, but maybe not to you specifically. We know that two men with advanced prostate cancer were treated with CAR-T at the University of Pennsylvania here in Philadelphia a couple of months or so ago.
As yet, what we do not know is whether these two men responded to treatment or not. I have reached out to people to try to find out, but I have been unable to get any answers as yet.
Thank you so much! I live in Hope!