PURPOSE:The number of patients in Sweden treated with radical prostatectomy for localized prostate cancer has increased exponentially.
The extent to which this increase reflects treatment of non-lethal disease detected through PSA screening is unknown. Experimental design: We undertook a nationwide study of all 18,837 prostate cancer patients treated with radical prostatectomy in Sweden from 1988 to 2008 with complete follow-up through 2009. We compared cumulative incidence curves, fit Cox regression and cure models, and performed a simulation study to determine changes in treatment, cancer-specific survival over time, and effect of lead-time due to PSA screening.
RESULTS:The annual number of radical prostatectomies increased 25-fold during the study. Five-year cancer-specific mortality decreased from 3.9% (95% CI 2.5 to 5.3) among patients diagnosed between 1988 and 1992 to 0.7% (95% CI 0.4-1.1) among those diagnosed between 1998 and 2002 (p for trend < 0.001). According to the cure model, the risk of not being cured declined by 13% (95% CI 12-14%) with each calendar year. The simulation study indicated that only half of the improvement in disease-specific survival could be accounted for by lead-time.
CONCLUSION: Patients overdiagnosed with non-lethal prostate cancer appear to account for a substantial and growing part of the dramatic increase in radical prostatectomies in Sweden but increasing survival rates are likely due to true reductions in risk of disease-specific death over time. Because the magnitude of harm and costs due to overtreatment can be considerable, identification of men who likely benefit from radical prostatectomy is urgently needed.
Written by:
Etzioni R, Mucci LA, Chen S, Johansson JE, Fall K, Adami HO. Are you the author?
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center.
Reference: Clin Cancer Res. 2012 Aug 27. Epub ahead of print.
doi: 10.1158/1078-0432.CCR-12-1537
PubMed Abstract
PMID: 22927485
UroToday.com Prostate Cancer Section
