Prostate cancer is the most common cancer in men in the US with a lifetime risk of 16.7%. In 2002, it is expected to account for 14.7% of all cancers and 29.6% of all cancers in men. This cancer is the third most common cancer seen at St. Anthony’s (SAH) accounting for 13.6% of all cases in the Cancer Registry, and for 28% of all cancers in men.  We reviewed 1,492 analytic cases in the registry from 1987 through the end of 2001 and present the data here with appropriate comparisons with national data (the NCI SEER data and the NCDB or national cancer data base).

          The incidence per year has been stable since the large up tick seen in 1992, which mirrored national trends and was thought to be due to the sudden emergence of PSA screening (figure 1). The median age was 73y  (figure 2) which was not much different from SEER (median 72y) though the age distribution was older than in the NCDB by almost a decade (figure 3). The racial distribution was 92% white and 7% black (NCDB was 74% and 12%).

The stage distribution and survival are shown below and NCDB comparisons in figures 4 and 5. Note that with the increasing use of PSA screening there has been a noticeable trend towards earlier stage disease at the time of diagnosis (figure 6). Survival (age adjusted or relative) for the whole group was 96% at 5 years and 84% at 10 years (the NCDB survival was 85% at 5 years).  Observed survival was 66%/5y and 37%/10y.

                  

Treatment with radical prostatectomy increased in the early 90’s commensurate with the increased incidence of early stage disease (figure 7), and has leveled off at about 30% of all patients (figure 8) and is primarily used in younger men (figure 9).

          It is difficult to make survival comparison between surgery or radiation but both forms of treatment appear to have excellent results.

Conclusion:

          Prostate cancer remains the most common malignancy in American men. With the advent of PSA screening these patients are now diagnosed at earlier stages more amendable to curative therapy. There remains controversy about the optimal therapy but the results with surgery and radiation appear to be similar. Because of the patient’s age, age adjusted survival is much longer than observed survival (84%/10 years versus 37%/10 years respectively). There remains controversy about the impact of therapy over watchful waiting because of the old age and relative indolent nature of prostate cancer. The recent randomized trial by Holmberg did show a survival advantage to treatment. Men diagnosed with early stage prostate cancer should be counseled about treatment options and issues related to morbidity and quality of life. The survival data and comparisons with national benchmark data show excellent survival outcomes in men treated at St. Anthony’s.