The survival rate for all cancers combined and for certain site-specific cancers have improved significantly since the 1970s, due, in part, to both earlier detection and advances in treatment. Survival rates markedly increased for cancers of the prostate, ovary, breast, colon & rectum, and for leukemia. With new treatment techniques and increased utilization of screening, there is hope for even greater improvements in the not-too-distant future.
Il carcinoma della prostata nel terzo millennio
1° CONVEGNO SIURO LOMBARDIA Il Carcinoma della prostata nel terzo millennio INTRODUZIONE G. Comeri Centro Convegni LE ROBINIE Solbiate Olona (Va) 25 ottobre 2008
American Cancer Society , Cancer Facts & Figures 2005 Annual Percentage of Change 1975-87 +0.9% 1987-91 +3.0% 1994-01 -4.1%
American Cancer Society , Cancer Facts & Figures 2005 Relative Survival Rates Survival in relation to men who do not have prostate cancer 1995-2005 stage at diagnosis 90% localized 5% distant
Relative Survival* (%) during Three Time Periods <ul><li>Breast (female) 75 78 87 </li></ul><ul><li>Colon & rectum 50 57 62 </li></ul><ul><li>Leukemia 34 41 46 </li></ul><ul><li>Lung & bronchus 12 14 15 </li></ul><ul><li>Melanoma 80 85 90 </li></ul><ul><li>Non-Hodgkin lymphoma 47 54 56 </li></ul><ul><li>Ovary 37 41 53 </li></ul><ul><li>Pancreas 3 3 4 </li></ul><ul><li>Prostate 67 75 98 </li></ul><ul><li>Urinary bladder 73 78 82 </li></ul>* 5-year relative survival rates based on follow up of patients through 2000 . Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003 . Site 1974-1976 1983-1985 1992-1999 2000 99% Relative to normal life expectancy
Changes in WHO Age-Adjusted Prostate Cancer Mortality Rates V Gr Sp Sw Be NoLu Ir Fi D It Ne Fr A Ca UK G US The decrease in the UK in the absence of widespread PSA screening is caused by a change in software that attributes cause of death.
PSA Screening Program and Its Effect on Tyrol’s Prostate Cancer Mortality Rate Horninger W, MD et al Am J Urol Review 2005 Apr 3:4, 172-175 1993 Mass screening project launched in Tyrol, Austria, offers PSA testing free to all men ages 45-75; 65,123 enrolled Treatment for Tyrol subjects with: Elevated PSA levels advised to undergo DRE and biopsies Organ-confined lesions RRP or EBR T3 lesions EBR only Metastases ADT No organized screening in the rest of Austria. Treatments varied. WJC
Population-Based Case-Control Studies <ul><li>Bergstralh J et al, Population-Based Case-Control Study of PSA and DRE Screening on Prostate Cancer Mortality (Rochester, MN) AUA Abstract 535 </li></ul><ul><li>Less screening in patients who died of CaP </li></ul><ul><li>Kopec et al, Screening with PSA and Metastatic Prostate Cancer Risk: Population-Based Case Control Study (Toronto, Ontario) AUA Abstract 541 </li></ul><ul><li>Less screening in men who developed metastases </li></ul>
Typical Pathology Diagrams of Prostates with Cancers in 2005 PSA Level: 2.5 2mm 3 PSA Level: 6.0 2mm 3 urethra urethra
Typical Pathology Diagrams of Prostates with Cancers in 1991 PSA Level: 2.5 2mm 3 15mm 3 PSA Level: 17.5 urethra urethra
T1c Patients with RRP by PSA at Diagnosis (PSA Follow-up Study,2005) 2.6-4.0 4.1-6.0 6.1-9.9 > 10 Number of Months 120 100 80 60 40 20 0 Probability of No PSA Progression 1.0 .9 .8 .7 .6 .5 .4 .3 .2 .1 0.0 Tumor volume is not the most important outcome
PSA Velocity <ul><li>More meaningful than the absolute PSA level </li></ul><ul><li>Increases over time </li></ul>
Use PSA Intelligently <ul><li>PSA provides a continuum of risk </li></ul><ul><li>Get away from PSA cutoffs </li></ul><ul><li>Rule out prostatitis and repeat PSA measurements </li></ul><ul><li>Use PSA density, PSA Velocity, and free and complexed PSA </li></ul>
Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. 7% 10% 17% 24% 27% 1% 1% 2% 5% 7% 0 5 10 15 20 25 30 ? 0-0.5 0.6-1.0 1.1-2.0 2.1-3.0 3.1-4.0 PSA Level (ng/ml) % of Men with Prostate Cancer and High- Grade Disease Percent with Prostate Cancer Percent with Gleason > 7 Disease Thompson IM, et al. N Engl J Med. 2004 May 27;350(22):2239-46 . (13%) (10%) (12%) (19%) (25%) Relationship of the PSA Level to the Prevalence of Prostate Cancer and High-Grade Disease
National Comprehensive Cancer Center Network (NCCN) Guidelines <ul><li>Begin screening at age 40 </li></ul><ul><li>If PSA > 0.6 ng/ml - screen annually </li></ul><ul><li>If PSA Velocity > 0.4, consider biopsy </li></ul><ul><li>If PSA = 2.6-4 ng/ml, consider biopsy </li></ul>National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology – v.1.2004, Prostate Cancer Early Detection