PATTERNS OF CARE FOR CARCINOMA OF THE PROSTATE-GLAND - RESULTS OF A NATIONAL SURVEY OF 1984 AND 1990

BACKGROUND: The annual incidence of carcinoma of the prostate gland in creased from an estimated 76,000 cases in 1984 to 200,000 in 1994. Par t of this increase may be the result of increased detection. Managemen t of the disease has also changed. To measure such changes, the Americ an College of Surgeons conducted a patient care evaluation study of ca rcinoma of the prostate gland. STUDY DESIGN: Information was voluntari ly submitted by cancer registrars on forms designed by a team of speci alists. Data were received from 730 hospitals (of 2,000 hospitals invi ted for the study) on 14,716 patients with newly diagnosed adenocarcin omas of the prostate gland in 1984 and from 1,035 hospitals for 23,214 patients with carcinoma of the prostate gland in 1990. RESULTS: From 1984 to 1990, there was increased diagnostic use of the prostate speci fic antigen (PSA) test (from 5.1 to 66.4 percent of incident carcinoma s) and transrectal ultrasound (TRUS) (0.9 to 19.7 percent). Use of the prostatic acid phosphatase assay declined from 62.4 to 47 percent. Al though the proportion of early stage (0, I, II) disease increased for all racial or ethnic groups combined, the greatest increase was for wh ites (from 57.3 to 60.6 percent), while the increase for African-Ameri cans was less (from 46.9 to 48.3 percent). The use of radical prostate ctomy without radiation therapy or chemotherapy increased from 7.3 to 20.3 percent and the proportion of patients receiving no carcinoma-dir ected treatment decreased from 37.8 to 30 percent. Radiation therapy r emained the same. Hormone therapy without radical prostatectomy declin ed from 24.4 to 19.7 percent. African-Americans had a lower five-year survival rate than whites, even when stratified for stage. CONCLUSIONS : The diagnostic use of the PSA test and TRUS increased markedly by 19 90 and may have contributed to the increased diagnosis of carcinomas o f the prostate gland and the earlier stage at diagnosis, The overall u se of radical prostatectomy has increased and the proportion of patien ts receiving no treatment has decreased. African-Americans had a lower five-year survival rate than other groups, even when stage was contro lled.