Page 21 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

POCS analysis found that the proportion of patients with no comorbidity increased from 78.3
percent in 1998 to 87.4 percent in 2002.

Race/Ethnicity
Eighteen studies (covering 1973–2003) reported information on race/ethnicity. No consistent
pattern in the racial or ethnic distribution of cases over time was found: some studies indicated
that the number of whites increased over time, others that it remained stable, and others that it
decreased. Studies using the same database often provided discrepant results even for
overlapping time periods; these findings may be a reflection of the different inclusion criteria
used in each study.

Tumor Stage
Twenty-two studies (covering 1973–2007) reported information on trends in the distribution
of prostate cancer stage at diagnosis. Studies reporting on cancer stage consistently demonstrated
decreases in the proportion of patients presenting distant disease and concomitant increases in
the proportion of patients with localized or regional disease, over their respective time periods.
Studies consistently demonstrated reductions in the proportion of patients presenting with higher
T stages. The two studies reporting on T1/T2 tumors both demonstrated a decrease of T1a/T1b
tumors and T2a tumors and an increase in T1c tumors.

Tumor Volume
We did not find data on changes in tumor volume.

Tumor Grade
Sixteen studies (covering 1973–2006) reported information on trends in the distribution of
tumor stage at diagnosis. These data consistently demonstrated reductions in the proportion of
patients diagnosed with well- or poorly-differentiated tumors (including undifferentiated tumors)
with concomitant increases in the proportion of patients with moderately-differentiated disease.

Prostate Specific Antigen
Eight studies (covering 1989–2007) reported PSA data. These studies indicated that PSA
values at diagnosis have decreased over time (i.e., that a larger number of patients are currently
diagnosed with PSA concentrations below 10 ng/mL).

Biopsy Frequency
Four studies (covering 1982–2001) reported information on trends in the performance of
prostate biopsies. A study based on the SEER-Detroit database reported that the proportion of
prostate cancer patients diagnosed through biopsy (compared to those diagnosed through other
procedures, such as transurethral resection of the prostate) increased over time. A similar trend
was observed in a study based on the SEER-New Mexico registry. A SEER-Medicare study
demonstrated an increase in the age-adjusted rate of biopsy procedures (from 685 to 2600 per
100,000 men) between 1986 and 1991. An update from the same database reported that there
was no statistically significant change in the population biopsy rate between 1993 and 2001.

ES-11