Page 20 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Comorbidity (Other Primary Cancers)
One study demonstrated that throughout 1988 to 1995 prostate cancer patients with other
primary tumors were consistently less likely to die of prostate cancer compared to patients with
no other primary tumors.

Race/Ethnicity
According to 15 studies (covering 1969–2000) reporting prostate cancer mortality and
survival rates stratified by race/ethnicity, mortality rates among blacks were consistently higher
compared to those of non-Hispanic whites. Similarly, black patients with prostate cancer were at
higher risk for death due to prostate cancer compared to non-Hispanic whites, although the
difference between these two groups appeared to decrease over time.

Tumor Stage
Six studies (covering 1969–2001) reported information on prostate cancer mortality stratified
by tumor stage. Data indicated that over time the proportion of deaths due to prostate cancer
among patients diagnosed with the disease had decreased, particularly for patients with early-
stage (localized or regional) disease at diagnosis.

Tumor Grade
Three studies reported information on prostate cancer mortality stratified by tumor grade (of
patients diagnosed in 1973–97). One study demonstrated that the probability of dying from
prostate cancer among patients diagnosed with prostate cancer decreased during the study period
(1988–95). Although the decrease was observed for all cancer grades, it was more pronounced
among patients with well- and moderately-differentiated tumors. The second study demonstrated
that, compared to patients with well differentiated tumors, patients with moderately and poorly
differentiated tumors had a higher probability of prostate cancer death (more than 2-fold and
more than 4-fold higher, respectively). These differences were relatively constant over the time
period covered by the study (1988–95). The third study demonstrated that patients with low
grade tumors have the highest relative survival compared to those with higher grade disease;
improvements in relative survival over time were observed for all tumor grades.

Patient, Tumor and System-Level Characteristics at Diagnosis

We identified 52 observational studies reporting on patient characteristics at presentation.

Age
Twenty-one studies (covering 1973–2005) reported information on patients’ age at
presentation. Among seven studies evaluating average age at diagnosis of prostate cancer, five
found reductions in the average age of patients whereas two studies did not report any changes
during their respective time periods. Fifteen studies that evaluated the distribution of patients’
ages into discrete categories generally supported a trend toward younger age at diagnosis (the
effect was significant in four of the six studies reporting statistical tests).

Comorbidity
Two studies (covering 1997–2003) reported information on comorbidities at diagnosis. The
CaPSURE analysis found no statistically significant difference in the distribution of patients with
no, one or two, or three or more comorbidities, when comparing 1997–99 versus 2000–03. The

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