Prostate cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study

Abstract

Background: The 5-year relative survival for prostate cancers diagnosed between 1990 and 1994 in the United States was very high (92%); however, survival in black males was 7% lower compared with white males. The authors updated these findings and examined survival by stage and race.

Methods: The authors used data from the CONCORD-2 study for males (ages 15-99 years) who were diagnosed with prostate cancer in 37 states, covering 80% of the US population. Survival was adjusted for background mortality (net survival) using state-specific and race-specific life tables and was age-standardized. Data were presented for 2001 through 2003 and 2004 through 2009 to account for changes in collecting SEER Summary Stage 2000.

Results: Among the 1,527,602 prostate cancers diagnosed between 2001 and 2009, the proportion of localized cases increased from 73% to 77% in black males and from 77% to 79% in white males. Although the proportion of distant-stage cases was higher among black males than among white males, they represented less than 6% of cases in both groups between 2004 and 2009. Net survival exceeded 99% for localized stage between 2004 and 2009 in both racial groups. Overall, and in most states, 5-year net survival exceeded 95%.

Conclusions: Prostate cancer survival has increased since the first CONCORD study, and the racial gap has narrowed. Earlier detection of localized cancers likely contributed to this finding. However, racial disparities also were observed in overall survival. To help understand which factors might contribute to the persistence of this disparity, states could use local data to explore sociodemographic characteristics, such as survivors' health insurance status, health literacy, treatment decision-making processes, and treatment preferences. Cancer 2017;123:5160-77. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Keywords: Epidemiology; Surveillance; and End Results (SEER) summary stage; cancer registries; early detection of cancer; population-based survival; prevention and control; prostate cancer; therapeutics; trends.

Figure 1

Prostate cancer 5-year, age-standardized net survival (%) for males (ages 15–99 years) diagnosed between 2001 and 2003 and between 2004 and 2009 and absolute change (%) are illustrated. States are grouped by US Census region. Note that data from 37 statewide cancer registries (covering 80.6% of the population) are ranked within US Census Region by the survival estimate for 2004 to 2009. Dark colors denote states affiliated with the National Program of Cancer Registries (NPCR), and pale colors denote states affiliated with the Surveillance, Epidemiology, and End Results (SEER) Program. An asterisk denotes states affiliated with both federal surveillance programs. Change (%) was not plotted if a survival estimate was not available for 1 calendar period or if 1 or more estimates were not age-standardized.

Figure 2

Prostate cancer 5-year, age-standardized net survival (%) is illustrated for males (ages 15–99 years) by state, race, and calendar period of diagnosis. Note that the pooled US survival estimate for each calendar period is indicated by the horizontal (solid) line with corresponding 95.0% and 99.8% control limits (dashed lines).