TRENDS IN THE STAGE-SPECIFIC INCIDENCE OF PROSTATE CARCINOMA IN THE DETROIT METROPOLITAN-AREA - 1973-1994

BACKGROUND. Much of the recent increase in prostate carcinoma incidenc e has been attributed to screening with prostate specific antigen (PSA ). Controversy exists as to whether this screening will ultimately imp act prostate carcinoma mortality. Until adequate time elapses since PS A screening became widespread, or a randomized trial of PSA screening is completed, the effect of PSA screening on prostate carcinoma mortal ity cannot be determined. In the interim, stage specific prostate carc inoma incidence rates may provide an indication of the effect of PSA s creening. METHODS. Annual stage specific age-adjusted prostate carcino ma incidence rates for the years 1973 through 1994 were obtained from the Metropolitan Detroit Cancer Surveillance System (MDCSS), a member of the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program, These incidence rates were analyzed for trends using Poisson regression analysis. RESULTS. There were 10,801 cases o f prostate carcinoma in black men and 31,501 in white men during the 2 2-year period. Incidence rates for stages of local and regional prosta te carcinoma reached a maximum in 1992 and 1993. Distant stage prostat e carcinoma incidence has steadily declined since 1989 (P < 0.001), th e year in which the increasing trend in the incidence rates for local and regional stage prostate carcinoma were first noted. CONCLUSIONS. T hese findings suggest that a substantial proportion of early stage pro state carcinoma detected by PSA is in fact clinically important and th at early detection of these carcinomas has resulted in a continuous de cline in the stage of metastatic prostate carcinoma since (C) 1996 Ame rican Cancer Society.