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. 2008 Nov;23(11):1809-14.
doi: 10.1007/s11606-008-0785-8. Epub 2008 Sep 16.

Screening, treatment, and prostate cancer mortality in the Seattle area and Connecticut: fifteen-year follow-up

Grace Lu-Yao  1 , Peter C Albertsen, Janet L Stanford, Therese A Stukel, Elizabeth Walker-Corkery, Michael J Barry
Affiliations

Screening, treatment, and prostate cancer mortality in the Seattle area and Connecticut: fifteen-year follow-up

Grace Lu-Yao et al. J Gen Intern Med. 2008 Nov.

Abstract

Background: Prior to introduction of the prostate-specific antigen (PSA) test, the Seattle-Puget Sound and Connecticut Surveillance, Epidemiology and End Results (SEER) areas had similar prostate cancer mortality rates. Early in the PSA era (1987-1990), men in the Seattle area were screened and treated more intensively for prostate cancer than men in Connecticut.

Objective: We previously reported more intensive screening and treatment early in the PSA era did not lower prostate cancer mortality through 11 years and now extend follow-up to 15 years.

Design: Natural experiment comparing two fixed population-based cohorts.

Subjects: Male Medicare beneficiaries ages 65-79 from the Seattle (N = 94,900) and Connecticut (N = 120,621) SEER areas, followed from 1987-2001.

Measurements: Rates of prostate cancer screening; treatment with radical prostatectomy, external beam radiotherapy, and androgen deprivation therapy; and prostate cancer-specific mortality.

Main results: The 15-year cumulative incidences of radical prostatectomy and radiotherapy through 2001 were 2.84% and 6.02%, respectively, for Seattle cohort members, compared to 0.56% and 5.07% for Connecticut cohort members (odds ratio 5.20, 95% confidence interval 3.22 to 8.42 for surgery and odds ratio 1.24, 95% confidence interval 0.98 to 1.58 for radiation). The cumulative incidence of androgen deprivation therapy from 1991-2001 was 4.78% for Seattle compared to 6.13% for Connecticut (odds ratio 0.77, 95% confidence interval 0.67 to 0.87). The adjusted rate ratio of prostate cancer mortality through 2001 was 1.02 (95% C.I. 0.96 to 1.09) in Seattle versus Connecticut.

Conclusion: Among men aged 65 or older, more intensive prostate cancer screening early in the PSA era and more intensive treatment particularly with radical prostatectomy over 15 years of follow-up were not associated with lower prostate cancer-specific mortality.

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Figures

Fig. 1
Fig. 1
Cumulative incidence of prostate cancer by study region.
Fig. 2
Fig. 2
Age adjusted prostate cancer mortality per 100,000 person-years for men in the Seattle–Puget Sound region and Connecticut on the basis of cross-sectional data, 1987-2001, adjusted to the age composition of the entire study cohort: 48.3% aged 70-74, 33.3% aged 75-79, 18.4% aged 80-84 as of 1 January 1992. (US data by SEER region, age, and race provided by LAG Ries, Cancer Statistics Branch, National Cancer Institute).
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