CHANGES IN PROSTATE-CANCER INCIDENCE AND TREATMENT IN USA

We examined time trends and geographical variations in the detection a nd treatment of prostate cancer in USA, based on information from whit e men aged 50 to 79 who resided in areas covered by the Surveillance, Epidemiology, and End Results (SEER) program of the United States Nati onal Cancer Institute. Prostate-cancer incidence and treatment rates w ere determined for the 9 population-based cancer registries which part icipate in the SEER program. Prostate-cancer mortality rates were asse ssed from data compiled by the National Center for Health Statistics. Prostate cancer incidence rates increased by 6.4% per year between 198 3 and 1989. The increase appeared to be due to detection of early-stag e disease; there was no increase in the incidence rate of metastatic c ancer. Incidence rates varied widely among the SEER program areas: in 1989 from 267.9 per 100 000 in Connecticut to 606.8 in Seattle. Radica l prostatectomy rates more than tripled between 1983 and 1989 in the S EER areas as a whole. Among men aged 70-79, the rate of prostatectomy increased by nearly 35% per year. There was a five-fold variation amon g SEER areas in radical prostatectomy rates in 1989, with a low of 43. 4 per 100 000 in Connecticut and a high of 224.4 in Seattle. Prostate cancer mortality rates did not increase during the period of study; th ere was little variation among areas in prostate-cancer mortality rate s, and no apparent correlation between the incidence and mortality rat es for an area. Increases in rates of prostate cancer incidence and pr ostate surgery have occurred in the United States without clear eviden ce that screening and prostectomy are effective in reducing mortality. Moreover, much of the growth in incidence and radical prostatectomy r ates has occurred among older men, who appear least likely to benefit from early detection and surgery of occult prostate cancer.