Page 52 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Key Question 1. How have the patient population and the natural history of
prostate cancer diagnosed in the United States changed in the last 30
years?
Prostate cancer epidemiology is affected by population-level trends, such as the aging of the
United States population, but also by changes in the application of screening and diagnostic
technologies among the population at risk. To assess temporal trends in the incidence,
mortality/survival, disease features at diagnosis, and treatment patterns we performed a search to
identify large studies (≥1000 men) utilizing databases sourced from the U.S. population that
provided information stratified by factors relevant to Key Question 1 (see the end of the
Introduction for the list of factors). We also reviewed the latest version of the Cancer Statistics
2
1
report prepared annually by the American Cancer Society , a recent SEER Survival Monograph ,
3
the 2009/2010 update of the Cancer Trends Progress Report , and data available on the SEER
a
Web site.
We identified 79 primary observational studies and one systematic review eligible for
inclusion in Key Question 1. 4,5,16-92
Of the primary observational studies, 51 analyzed the Surveillance Epidemiology and End
Results (SEER) database of the National Cancer Institute (NCI) or a subset of its component
registries, nine additional studies utilized the linked SEER-Medicare database, 11 the Cancer of
the Prostate Urologic Research Endeavor (CaPSURE) database, five the National Cancer
Database (NCDB), and three analyzed other large U.S.-based databases.
• The SEER database consists of a coordinated system of population-based cancer
registries covering geographic areas selected for inclusion based on their ability to
provide high quality population-based cancer reporting and for their epidemiologically
significant population subgroups. The SEER population is comparable to the general U.S.
population with regard to measures of poverty and education; however, the SEER
population tends to be somewhat more urban and has a higher proportion of foreign-born
b
persons than the general U.S. population.
• The racial and age distribution on SEER areas is also not perfectly representative of the
total U.S. population and the data may be insufficient for minority groups other than
blacks. 93,94
• The SEER-Medicare database linked the SEER cancer registries data and Medicare
c
enrollment and claims files.
• A comparison of sociodemographic characteristics of Medicare beneficiaries residing in
the SEER areas versus the general U.S. elderly population demonstrated that the age and
sex distribution for individuals 65 years and older in the SEER areas was comparable to
that of the U.S. elderly population. However, the elderly population in the SEER areas
had a lower proportion of whites and a higher proportion of other racial/ethnic groups and
was also more likely to reside in an urban setting compared with the average 65 years and
95
older U.S. population.
• The CaPSURE database includes data from a longitudinal, observational study of over
14,000 men with all stages of biopsy-proven prostate cancer. Patients are enrolled
regardless of age, stage of disease, or intended treatment plan. Currently, CaPSURE

a Available at http://seer.cancer.gov/faststats/; last accessed September 30, 2011.
b http://seer.cancer.gov/registries/characteristics.html ; last accessed September 30, 2011.
c See http://healthservices.cancer.gov/seermedicare/; last accessed September 30, 2011.

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