The epidemiology of prostate cancer (2003-2017)

A recent report in the CDC’s Morbidity and Mortality Weekly Report (MMWR) may offer one of the best analyses of an increasing risk for diagnosis with and death from advanced forms of prostate cancer over the period from 2003 to 2017 (the last year for which we have accurate data from the SEER database).

There are a number of very important points made in this analysis, which we shall quote directly, so that readers are clear that these are CDC’s statements and not those of Prostate Cancer International:

  • “Among 3.1 million new cases of prostate cancer recorded during 2003–2017, localized, regional, distant, and unknown stage prostate cancer accounted for 77%, 11%, 5%, and 7% of cases, respectively.”
  • “Over this 15-year period, age-adjusted incidence decreased from 155 per 100,000 in 2003 to 105 in 2017.”
  • “During 2001–2016, 10-year relative survival for localized stage prostate cancer was 100%.”
  • “The percentage of distant stage prostate cancer increased from 4% in 2003 to 8% in 2017.”
  • “Five-year survival for distant stage prostate cancer improved from 28.7% during 2001–2005 to 32.3% during 2011–2016.”
  • “Overall, 5-year survival for distant stage prostate cancer improved from 28.7% during 2001–2005 to 32.3% during 2011–2016.”
  • “For the period 2001–2016, 5-year survival was highest among Asian/Pacific Islanders (42.0%), followed by Hispanics (37.2%), American Indian/Alaska Natives (32.2%), Black men (31.6%), and White men (29.1%).”

There are also some clarifying statements in the paper’s Discussion section:

  • Over the study time period “an increasing number and percentage of men have received diagnoses of distant stage prostate cancer.”
  • “In 2012, USPSTF concluded that the benefits of PSA-based screening do not outweigh the harms and recommended against PSA-based screening for prostate cancer for men of all ages. This recommendation likely contributed to a decrease in overall reported prostate cancer incidence and might have contributed to an increase in the percentage and incidence of distant stage prostate cancer.”
  • “Survival with distant stage prostate cancer has improved, but fewer than one third of men survive 5 years after diagnosis.”
  • Among men initially diagnosed with localized prostate cancer “≤ 6% progress to metastatic prostate cancer.”
  • “Survival for distant stage prostate cancer was higher for Black than White men, which is different from a past study reporting higher survival for White men than Black men during 2001–2009.”

We would note that it is now nearly 4 years since the last time point encompassed by this data set. Whether anything significant has changed during that time period is something we won’t know until about 2024.

The other thing that is important to understand about this study (like any other epidemiological analysis) is that there are a series of statistical and other assumptions that have to be made in carrying out such an analysis. If those assumptions are inaccurate (and we have no reason to believe that they are), it could lead to inaccurate results.

The reason that we want to bring attention to this analysis is that there is no reason to accuse the CDC of any bias in offering these data. The CDC doesn’t treat patients. It doesn’t pay for the treatment of patients. And it’s sole interest is in providing objective information about specific disorders identified within the USA.

3 Responses

  1. Since the incidence of overall prostate cancer has decreased by about a third from 2003 to 2017, the absolute numbers of men with distant stage prostate cancer have increased by only about 25%. This is high enough but looks better than the relative increase from 4% to 8%.

  2. I find the use of the terms localized, regional, and distant a bit ambiguous although they may well have been more accurately described within the CDC paper. “Organ confined” is an important distinction. The first spread beyond the prostate organ itself is often (I believe) to the seminal vesicles and the abdominal lymph nodes but could also be to the rectum and or bladder. There is a specific staging nomenclature TNM which is perhaps not that helpful to the layman.

    I have also seen the use of “localized” and “locally advanced” which mean two different stages. Localized = to organ confined. Does regional mean the same as locally advanced?

  3. Dear Charles:

    The TNM staging system is widely considered to be the most accurate clinical and pathological staging system in use today, and I would encourage any wise patient and any good patient advocate to make sure that they fully understand this staging system.

    The term “organ-confined” is and should be used to apply exclusively to cancer that is confined to the prostate gland itself.

    The term “localized” is normally used to apply to cancer that is confined to the prostate and the seminal vesicles (i.e., tissues that would normally be surgically removed at the time of radical prostatectomy), along with any immediately surrounding tissues of the prostate bed that exhibit cancer that has grown into or through the capsule of the prostate and into the surrounding tissues of the prostate “bed”.

    The terms “locally advanced” and “regional” are normally used to apply to cancer that has spread into the pelvic lymph nodes.

    The problem, of course, is that all this medical terminology and the ability to interpret it depends on the level of education of the person using it (usually a doctor) and the person hearing it (usually a patient or a patient’s spouse or partner). The reason that the CDC uses the terms “localized”, “regional”, and “distant” (i.e., metastatic) is because they are trying to keep things as simple as possible for the average patient with limited initial education about both anatomy and the classifications of prostate cancer.

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