Page 19 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Race/Ethnicity
According to the 17 studies (covering 1973–2005) reporting incidence rates stratified by
race/ethnicity, all groups experienced increases in prostate cancer incidence since the mid-1980s.
The incidence rate appears to have peaked in the early 1990s for all racial/ethnic groups.

Tumor Stage
Fifteen studies (covering 1969–2005) reported incidence data, stratified by tumor stage.
These studies consistently demonstrated that early-stage (localized and regional) prostate cancer
cases were responsible for the observed increase in prostate cancer incidence from the mid-1980s
up to the mid-1990s. Studies also consistently indicated a decrease in incidence rates for all
disease stages from the mid-1990s to 2000. A single study investigated trends in incidence
stratified by T stage, and demonstrated that compared to 1988–89 the incidence rate in 2004–05
reflected an increase of 76 cases per 100,000 person-years for T1 tumors (from a baseline rate of
42.3 cases per 100,000 person-years) and 11.2 cases per 100,000 person-years for T2 tumors
(from a baseline of 95 cases per 100,000 person-years). In contrast, the incidence of T3 or T4
tumors (combined) decreased by 47.1 cases per 100,000 person-years (from a baseline of 55.5
cases per 100,000 person-years) over the same time period.

Tumor Grade
Five studies (covering 1973–2005) reported prostate cancer incidence rates stratified by
tumor grade (level of tumor differentiation or Gleason score). In studies using SEER data, the
increase in prostate cancer incidence observed from the mid-1980s to early 1990s was mainly
due to an increase in the incidence rate of moderately differentiated tumors (corresponding to
Gleason score 5–6). A single study using SEER data after 2000 reported a continued increase in
incidence rate of moderately differentiated tumors from 1988 to 2005 and a concomitant
decrease in the incidence rate of well differentiated tumors (corresponding to Gleason score 2–
4).

Trends in Prostate Cancer Mortality and Survival Rates

For the overall U.S. population, the NCI’s Cancer Trends Progress Report (2009/10)
indicates that, after increasing from 1975 to 1991, prostate cancer death rates fell from 1994 to
2007. The baseline prostate cancer mortality in 1975 was 31 deaths per 100,000 men per year
and has declined to the current level of approximately 24 deaths per 100,000 men per year.
Overall, 17 studies provided information on trends of prostate cancer mortality or survival after
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diagnosis.

Age
Nine studies (covering 1969–2003) reported prostate cancer mortality and survival rates
stratified by age group. Collectively, they demonstrated decreases in the mortality rate for all age
groups between the early 1990s and 1999. One study of prostate cancer-specific survival
indicated that over time (1988–95) the proportion of patients diagnosed with prostate cancer who
died of their cancer had decreased (i.e., patients with prostate cancer have increasingly died of
other causes) across all the age groups considered (>50 years old).

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