Trends in the utilization of androgen-deprivation therapy for patients with prostate carcinoma suggest an effect on mortality

BACKGROUND. After a surge in the incidence of prostate carcinoma in the ear ly 1990s, diminishing rates of mortality became apparent in 1993. This decr ease in mortality is unlikely to be explained entirely by treatment with cu rative intent alone following screen-detected cases, because the time frame between detection and mortality remains relatively brief. METHODS. This study used incidence and initial treatment data from the Detr oit area SEER registry between 1973 and 1998 in addition to mortality data covering the Metropolitan Detroit area obtained from the Michigan Departmen t of Community Health. Data for Caucasian and African -American men were an alyzed. The use of androgen-deprivation therapy, which evolved during the s tudy period, was evaluated in conjunction with mortality and incidence tren d data for consideration of etiologic contributions. RESULTS. The incidence of prostate carcinoma, as noted previously in nation al data, increased sharply in 1988, peaking in 1992 in Southeast Michigan, whereas mortality rates began to decrease in approximately 1993, with a sus tained decrease to the latest recorded data in 1998. These trends were iden tical in Caucasians and African Americans. A sharp increase in the use of a ndrogen - deprivation therapy began in 1990. This use of androgen- deprivat ion therapy is high and sustained for patients with early-stage disease, in creases for several years, and then diminishes for patients with regional d isease. The use also diminished through the 1990s for patients with late-st age disease, paralleling the decrease in the incidence rate for late-stage disease. CONCLUSIONS. The pattern of androgen- deprivation therapy usage was consist ent with that for hormonal monotherapy and adjuvant and neoadjuvant therapy . These findings suggest that androgen- deprivation therapy may contribute, along with advances in diagnostic techniques and curative therapy with rad iation or surgery, toward decreasing prostate carcinoma mortality rates in Southeast Michigan. (C) 2001 American Cancer Society.