 |
|
|
|
|
|
Prostate cancer is the most common cancer in men in the US with a lifetime risk of 17.1%. In the US it accounts for 16% of all cancers and 33% of all cancers in men. It is the third most common cancer seen at St. Anthony’s (SAH) accounting for 14.2 % of all cases in the Cancer Registry, and for 29% of all cancers in men. We reviewed 1,786 analytic cases in the registry from 1987 through the end of 2004 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). Overall breast cancer is becoming more common at SAH (figure 2.) The age distribution is shown with the median age of 73y, 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 90% white and 9% black (NCDB was 74% and 12%). The stage distribution and survival are shown with NCDB comparisons in figure 4 and figure 5. Since the widespread use of PSA screening, this cancer is almost always picked up in the earliest stages (see figure 4). Survival (age adjusted or relative) for the whole group was 100% at 5 years (the NCDB survival was 85% at 5 years) and 94% at 10 years. Observed survival was 69% at 5 years. According to the current guidelines from the National Comprehensive Cancer Network (www.NCCN.org) the treatment options for patients with early stage disease include observation, surgery or radiation. The distribution of therapy by stage is shown in figure 6 for SAH and figure 7 for the NCDB. Comparing treatments for Stage II (the most common group) the treatment distribution is quite similar (figure 8). Conclusion: Prostate cancer remains a major source of morbidity in the United States. The incidence, stage distribution, treatment disposition and survival data at SAH compares favorably with the appropriate national benchmark data. New screening guidelines from the NCCN encourage considering a biopsy for patients with PSA greater than 2.5 which is a change from previous years and even consider evaluation for patients with PSA greater than 0.6 if the man is still in his forties. Controversy remains as to optimal treatment with most patients opting for radical prostatectomy or radiation (external beam or seed implants.) New technologies (cryosurgery, robotic surgery and proton beam) continue to be explored as efforts continue to lower the morbidity associated with the treatment of a disease that remain indolent in many men. Patients should be offered the various treatment options as detailed in the NCCN guidelines. |
