Patterns of care for metastatic carcinoma of the prostate gland: results of the American College of Surgeons' patient care evaluation study

The annual incidence of prostate cancer more than doubled between 1984 and 1990, increasing from an estimated 76 000-200 000 cases respectively. Part of this increase may have been the result of increased detection. This stud y utilizes data from an American College of Surgeons Patient Care Evaluatio n (PCE) study to report on changes in the management of metastatic disease. Approximately 2000 hospitals were invited to submit data on a standard coll ection form designed by a multidisciplinary committee of specialists. Data were received from 730 hospitals on 14 716 patients with newly diagnosed ca ncer of the prostate in 1984, and from 1035 hospitals for 23 214 patients i n 1990. Between 1984 and 1990 there was a decrease in the percentage of reported pa tients diagnosed with Stage IV disease, falling from 25.3-21.2%. The number of patients receiving a prostate specific antigen (PSA) test increased fro m 6.3-74.8% and the proportion of abnormal PSA results increased from 82-92 .7%. The proportion of patients diagnosed by transurethral resection of the prostate (TURP) and perineal biopsy decreased, while an increase was noted in the proportion of men diagnosed by transrectal biopsy and transrectal u ltrasound (TRUS). Treatment by orchiectomy alone increased from 31.8-40.7% of patients, while the administration of exogenous hormone therapy alone de clined from 22.3-14.9% of patients. Two and five-year survival rates for th e most common forms of therapy were 56.7% and 22.5% respectively for orchie ctomy, 57% and 24.6% respectively for exogenous hormone therapy, and 50.3% and 23.5% respectively for no cancer directed therapy. Following a second c ourse of therapy, the two-year survival rate for patients receiving a subse quent orchiectomy was 36.7 vs 17.8% for those receiving secondary exogenous hormone therapy. The percentage of patients diagnosed with Stage IV disease has decreased wh ile prostate cancer diagnoses are being made more frequently utilizing the PSA test and TRUS biopsies. Hormone treatment remains the most common form of therapy with either orchiectomy or exogenous hormone therapy having high er survival rates than other common treatment modalities.