Study shows massive drop in risk for diagnosis with more advanced forms of prostate cancer

The "New" Prostate Cancer Infolink | 08.28.2009

Please note that this report has been modified from the original now that we have been able to obtain an actual copy of the full paper.

According to a new report by Grace Lu-Yao and colleagues, published yesterday in the Journal of the National Cancer Institute, “Men with prostate cancer are being diagnosed at a younger age and earlier stage today than in years past, and the racial disparity in stage at diagnosis has decreased significantly.”

Media reports on this study seem to be focused on the younger age issue and on the fact that the disparities between diagnosis in blacks and whites has decreased. However, what stood out to The “New” Prostate Cancer InfoLink was the absolutely massive drop in the risk for initial diagnosis with T3 and T4 disease.

This study by Shao et al. compared data on 82,500 men diagnosed in 1988-89, 1996-97, and 2004-05, and showed that:

The overall incidence of patients being diagnosed with clinical stage T3 and T4 disease fell from 55.5 per 100,000 in 1988-89 to 44.6 per 100,000 in 1996-97 to 8.4 per 100,000 in 2004-05.
The incidence of men being diagnosed with a biopsy score of Gleason 8-10 fell from 47.5 per 100,000 in 1988-89 to 38.3 per 100,000 in 2004-05
The incidence of patients being diagnosed with clinical stage T3 and T4 disease fell from 52.7 to 7.9 per 100,000 among whites and from 90.9 to 13.3 per 100,000 among blacks between 1988-89 and 2004-05.
Among newly diagnosed patients in 20042005, 94 percent had localized (i.e., clinical stage T1 or T2) prostate cancer and a median PSA level of 6.7 ng/ml.

To put these data in a simpler perspective, what this means is that:

Among newly diagnosed men in the USA, there was only a 19.6 percent reduction in risk for diagnosis with locally advanced prostate cancer between 1988-89 and 1996-97 (which equates to roughly the first 8 years during which PSA testing was available).
Among newly diagnosed men in the USA, there was an 81.2 percent reduction in risk for diagnosis with locally advanced prostate cancer between 1996-97 and 2004-05 (which equates to roughly the second period of 8 years during which PSA testing was available).
Among white men in the USA, there was an 85.0 percent reduction in risk for diagnosis with locally advanced disease between 1988-89 and 2004-05.
Among black men in the USA, there was an 85.4 percent reduction in risk for diagnosis with locally advanced disease in the same time period.
In 2004-05, only about 6 percent of patients diagnosed with prostate cancer were diagnosed with non-localized disease.

That is a truly huge risk reduction over the 15-year period studied by Lu-Yao and her colleagues - for whites and for blacks. And the only possible rationale for that risk reduction is the existence and application of the PSA test (for all of its flaws).

Interestingly, although there has been a decline in the average age of diagnosis (from about 72 years in 1988-1989 to about 67 years in 2004-2005), this reduction in age is nothing like as major as the reduction in risk for a diagnosis with locally advanced disease.

The “New” Prostate Cancer InfoLink believes that these data truly emphasize the significance of the PSA test as an an important test for men at potential risk for prostate cancer. Based on these data, the PSA test very clearly must have reduced risk for a diagnosis of locally advanced prostate cancer, thus allowing patients to be treated for risk of progressive disease as opposed to needing to be treated for a disease that was already at least locally advanced (and potentially micrometastatic) by the time it was identified.

We are only beginning to think better about how to treat all the men diagnosed today with early stage, localized disease, but at least we have made a huge step forward in preventing the risk of diagnosis with advanced or micrometastatic disease.

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