THE RESULTS OF PROSTATE CARCINOMA SCREENING IN THE US AS REFLECTED INTHE SURVEILLANCE, EPIDEMIOLOGY, AND END RESULTS PROGRAM

BACKGROUND. The rapid escalation in the incidence of prostate carcinom a between the years 1988 and 1992 has been attributed to prostate spec ific antigen screening. There have been concerns regarding the possibl e diagnosis and treatment of insignificant tumors in the absence of ra ndomized, controlled trial evidence of a decrease in mortality. Descri ptive studies suggest that serial screening decreases the detection of advanced disease. In November 1996, the National Center for Health St atistics recorded a decrease in prostate carcinoma mortality. METHODS. The basis of this analysis is 208,234 prostate carcinoma cases diagno sed between 1973 and 1993 in population-based Surveillance, Epidemiolo gy, and End Results registries. The general staging system was used ra ther than that of the American Joint Committee on Cancer to permit obs ervation of long term trends. Grade incorporating Gleason scores was u sed as an indication of the significance of the prostate carcinoma. Ag e-adjusted survival rates were used to separate prostate carcinoma dea ths from deaths due to other causes. RESULTS. The increase in the inci dence of prostate carcinoma has been greater than for any other malign ancy. The increase was largely in Grade 2 significant tumors and not i n Grade 1 (15%) insignificant tumors. There was a decrease in the dete ction of advanced disease. After the peak incidence in 1992, a progres sive decrease to near baseline levels occurred. Approximately 38% of a ll deaths were from prostate carcinoma. Deaths from other causes incre ased with age. When corrected for death from other causes, men age > 6 9 years had a greater rate of death from prostate carcinoma than men a ge 50-69 years. Approximately 61% of all deaths from prostate carcinom a occurred within 5 years of diagnosis and 88% within 10 years. The 10 -year survival rate for patients treated by radical prostatectomy was 100%, 78% for patients treated by radiation, and 33% for patients trea ted with other (noncomparable modalities). CONCLUSIONS. The indirect e vidence suggested that prostate carcinoma screening of men ages >50 ye ars decreased the incidence of distant disease, which influences the m ortality rate. (C) 1997 American Cancer Society.