Prostate Cancer
St. Anthony’s Hospital 1987 – 2002

     Prostate cancer is the most common cancer in men in the US with a lifetime risk of 16.7%. This cancer is the third most common cancer seen at St. Anthony’s (SAH) accounting for 13 % of all cases in the Cancer Registry, and for 28% of all cancers in men.  We reviewed 1,570 analytic cases in the registry from 1987 through the end of 2002 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, which was not much different from SEER (median 72y) though the age distribution was older than in the NCDB by almost a decade. The racial distribution was 90% white and 8% black (NCDB was 74% and 12%).

     The stage distribution and survival are shown below and NCDB comparisons in figure 2 and figure 3.. 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 4 and figure 5). Survival (age adjusted or relative) for the whole group was 98% at 5 years (the NCDB survival was 85% at 5 years). Observed survival was 68% at 5 years.


SEER Stage Distribution and Survival

Stage

Number

Age

Survival

National

0

14 (1%)

71.5y

100%

100%

Local

1156 (74%)

73y

100%

100%

Regional

265 (17%)

71y

100%

100%

Distant

92 (6%)

78y

30%

34%

 

AJCC Stage Distribution and Survival

Stage

Number

Percent

Age

Survival/5y (SAH)

Survival/5y
(NCDB)

0

96

6%

76y

99%

88%

I

259

16%

75y

100%

92%

II

716

46%

71y

100%

91%

III

187

12%

70y

100%

91%

IV

132

8%

75y

55%

48%

 

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

          It is difficult to make outcome comparison between surgery or radiation but both forms of treatment appear to have excellent results based on survival. (PSA control rates are considered a better measure of outcome but complete data was not available on enough patients to make this comparison.)
 

Age adjusted Survival for Stage I/II Prostate Cancer by Therapy

Therapy

Number

Age

Survival at 8 years

Surgery

273

67

100%

Seeds

132

70y

100%

Extern. Radiation

477

72y

100%

 

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. The recent completion of the Proscar prevention trial has created controversy about prevention strategies at this time. There remains controversy about the optimal therapy but the results with surgery and radiation appear to be similar and other techniques like cryosurgery are still being investigated. Men diagnosed with early stage prostate cancer should be counseled about treatment options and issues related to morbidity and quality of life, as per the guidelines from the NCI and the NCCN. The survival data and comparisons with national benchmark data show excellent survival outcomes in men treated at St. Anthony’s.