NATIONAL TRENDS IN THE EPIDEMIOLOGY OF PROSTATE-CANCER, 1973 TO 1994 - EVIDENCE FOR THE EFFECTIVENESS OF PROSTATE-SPECIFIC ANTIGEN SCREENING

Objectives. The use of prostate-specific antigen (PSA) to screen for p rostate cancer remains controversial. Although it is still too early t o measure directly the effects of PSA screening on mortality, we exami ned changes in the epidemiology of prostate cancer to determine if the re is other evidence of the effectiveness of PSA as a screening tool. Methods, We examined trends in age at diagnosis, and age-adjusted tren ds in stage and grade at diagnosis, for 140,936 white and 15,662 Afric an American men diagnosed with prostate cancer from 1973 to 1994 in th e National Cancer institute's Surveillance Epidemiology and End Result s data base. Results. We found a significant downward trend in age at diagnosis, concomitant with a downward shift in stage of disease at di agnosis, starting with the advent of the PSA era in the late 1980s. We noted most cancers detected since the PSA era to be moderately well d ifferentiated (International Classification of Diseases of the World H ealth Organization grade 2; Gleason score 5, 6, 7) and organ confined. Although findings were similar for both whites and African Americans, African Americans experienced a greater increase in poorly differenti ated disease than did whites. Conclusions: Changes in the epidemiology of prostate cancer since the advent of the PSA era are consistent wit h the introduction of an effective screening test. This is evidenced b y an increase in detection of significant prostate cancer in individua ls who will likely benefit from treatment. UROLOGY 52: 444-449, 1998. (C) 1998, Elsevier Science Inc. All rights reserved.