The results of prostate carcinoma screening in the U.S. as reflected in
the surveillance, epidemiology, and end results program.

Cancer 1997;80(9):1835-44

Smart CR
Early Detection Branch, National Cancer Institute, Bethesda, Maryland, USA.
AB - BACKGROUND: The rapid escalation in the incidence of prostate
carcinoma between the years 1988 and 1992 has been attributed to
prostate specific antigen screening. There have been concerns
regarding the possible diagnosis and treatment of insignificant
tumors in the absence of randomized, controlled trial evidence of a
decrease in mortality. Descriptive studies suggest that serial
screening decreases the detection of advanced disease. In November
1996, the National Center for Health Statistics recorded a decrease
in prostate carcinoma mortality. METHODS: The basis of this analysis
is 208,234 prostate carcinoma cases diagnosed between 1973 and 1993
in population-based Surveillance, Epidemiology, and End Results
registries. The general staging system was used rather than that of
the American Joint Committee on Cancer to permit observation of long
term trends. Grade incorporating Gleason scores was used as an
indication of the significance of the prostate carcinoma. Age-
adjusted survival rates were used to separate prostate carcinoma
deaths from deaths due to other causes. RESULTS: The increase in the
incidence of prostate carcinoma has been greater than for any other
malignancy. The increase was largely in Grade 2 significant tumors
and not in Grade 1 (15%) insignificant tumors. There was a decrease
in the detection of advanced disease. After the peak incidence in
1992, a progressive decrease to near baseline levels occurred.
Approximately 38% of all deaths were from prostate carcinoma. Deaths
from other causes increased with age. When corrected for death from
other causes, men age > 69 years had a greater rate of death from
prostate carcinoma than men age 50-69 years. Approximately 61% of all
deaths from prostate carcinoma occurred within 5 years of diagnosis
and 88% within 10 years. The 10-year survival rate for patients
treated by radical prostatectomy was 100%, 78% for patients treated
by radiation, and 33% for patients treated with other (noncomparable
modalities). CONCLUSIONS: The indirect evidence suggested that
prostate carcinoma screening of men ages >50 years decreased the
incidence of distant disease, which influences the mortality rate.