Implications of stage-specific survival rates in assessing recent declinesin prostate cancer mortality rates

It has been noted that the most important evidence for a benefit of early d etection of prostate cancer using prostate specific antigen (PSA) testing w ould be a decline in prostate cancer mortality rates to levels below those existing before diagnostic use of PSA testing. We document a decrease in U. S. prostate cancer mortality rates in white men less than 85 years of age t o levels below those existing in 1986, the year use of PSA testing was appr oved. In fact, for men 60-79 yeats of age, prostate cancer mortality rates were lower in 1997 than in any year since 1950. Although it has been argued that the decrease in prostate cancer mortality rates began too soon to be explained by PSA testing, stage-specific survival rates indicate that a rap id decrease in mortality may be explained by the large number of high-grade prostate cancers detected before metastasis. If recent decreases in U.S. p rostate cancer mortality rates are due to early detection using PSA testing , randomized clinical trials investigating PSA testing will show early evid ence of a mortality benefit.