Page 56 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Patient Characteristics
Age. Eleven studies (9 SEER, 2 SEER-Medicare) covering 1969 to 2005 provided information
on prostate cancer incidence stratified by patient age. 17,27,28,35,38,39,43,55,57,59,79 Generally, studies
indicated that since the mid-1980s the prostate cancer incidence rate increased across all age
groups until 1992-93 and then declined until 1995-99. Data for more recent years were sparse.
However, based on a study utilizing the SEER database, compared to the pre-PSA era (1986), the
incidence rates in 2005 were 3.64 times higher for men aged 50-59 years (95 percent CI 6.4-8.2),
1.91 times higher for men aged 60-69 (95 percent CI 1.8-2.0), 1.09 times higher for men aged
70-79 years (95 percent CI 1.05-1.14), but 0.56 times less common for men 80 years or older (95
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percent CI 0.53-0.60).

Race/ethnicity. Seventeen studies (15 SEER, 1 SEER-Medicare, 1 LAC/USC) covering 1973 to
2007 provided information on prostate cancer incidence stratified by patient
race/ethnicity. 16,17,19,21,25,32,34,42,43,45,46,49,57,76,80,83,84 Thirteen of the 17 studies provided information
exclusively for whites or blacks and only four provided information on patients belonging to
other racial or ethnic groups; data for other racial/ethnic groups were often only provided in
aggregate (not separately for each ethnic group). Studies indicated that all racial/ethnic groups
experienced increases in prostate cancer incidence since the mid-1980s. The incidence rate
appears to have peaked in 1992 for non-Hispanic whites, in 1993 for blacks, and in 1992 for
“other” racial/ethnic groups. For all groups, incidence rates declined between the early-1990s
and 1999. One study that provided information up to 2005, reported that the incidence rates in
recent years are higher compared to the pre-PSA era but lower than the peak values reached in
the mid-1990s both for whites and blacks (both races P < 0.001 for the increase from 1988-89 to
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2004-05).
Tumor Characteristics
Stage. Fifteen studies (14 SEER, 1 LAC/USC) covering 1969 to 2005 provided information on
prostate cancer incidence stratified by tumor stage at diagnosis. 17,18,20,23,26,27,34,35,42,50,52,55,56,76,85
Fourteen studies investigated trends in the incidence of localized/regional and distant disease.
Generally, studies consistently demonstrated that early-stage (localized and regional; several
studies did not report data separately for these stages) prostate cancer cases were responsible for
the observed increase in prostate cancer incidence from the mid-1980s up to the mid-1990s.
When separate estimates were available, studies reported large increases in the incidence of
localized disease after the introduction of PSA testing. Over the same period, studies
demonstrated decreases in distant (metastatic) prostate cancer incidence. For example, following
the introduction of PSA screening, a study using the SEER-Seattle-Puget Sound registry
demonstrated a 60 percent decrease in the age-adjusted incidence rate of distant prostate cancer
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(P < 0.001 comparing 1986 to 1991). Studies also consistently demonstrated decreases in
incidence rates for all disease stages from mid-1990s to 2000. No study reported relevant
information after 2000.
A single study (analyzing SEER) investigated changes in the distribution of T stage over time
and demonstrated that compared to 1988-89, in 2004-05 the incidence rate had increased by 76
cases per 100,000 person-years for T1 tumors and by 11.2 cases per 100,000 person-years for T2
tumors. In contrast, over the same time period, the incidence of T3 or T4 tumors (combined) had
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decreased by 47.1 cases per 100,000 person-years (P < 0.001 for the stage specific changes).

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