Impact of screening on prostate cancer rates and trends

Widespread implementation of prostate cancer screening has affected several epidemiologic features of the disease induding incidence, tumor and patien t characteristics, patterns of care and outcomes. Some of these changes hav e been interpreted as evidence of the success of PSA testing as a cancer co ntrol strategy. Data are available from multiple sources to assess the asso ciation of early detection on recent prostate cancer rates and trends. Nati onal mortality data in the United States may be particularly informative be cause of the early and widespread adoption of PSA testing there. Incidence data from tumor registries and other regional resources are also relevant t o this question. Case-control analyses and modeling of relevant rates and t rends have recently been reported. Multiple sources of data show that prost ate cancer incidence rates rose following the introduction of PSA testing. The average age at diagnosis has fallen, the proportion of advanced stage t umors has declined, the proportion of moderately differentiated tumors has increased, and patterns of care have changed accordingly. A decline in mort ality began in the United States in 1991. The decline in mortality is well established but this recent trend may only retrace an increase in mortality that immediately preceded. The descriptive epidemiology of prostate cancer reveals many effects of the introduction of prostate cancer screening. Alt hough the evidence suggests increased prostate cancer testing has yielded p ublic health benefit, this has not yet been shown conclusively. (C) 2000 Wi ley-Liss. Inc.