Screening, treatment, and prostate cancer mortality in the Seattle area and Connecticut: fifteen-year follow-up.
BACKGROUND
Prior to introduction of the prostate-specific antigen (PSA) test, the Seattle-Puget Sound and Connecticut Surveillance, Epidemiology and End Results (SEER) areas had similar prostate cancer mortality rates. Early in the PSA era (1987-1990), men in the Seattle area were screened and treated more intensively for prostate cancer than men in Connecticut.


OBJECTIVE
We previously reported more intensive screening and treatment early in the PSA era did not lower prostate cancer mortality through 11 years and now extend follow-up to 15 years.


METHODS
Natural experiment comparing two fixed population-based cohorts.


METHODS
Male Medicare beneficiaries ages 65-79 from the Seattle (N = 94,900) and Connecticut (N = 120,621) SEER areas, followed from 1987-2001.


METHODS
Rates of prostate cancer screening; treatment with radical prostatectomy, external beam radiotherapy, and androgen deprivation therapy; and prostate cancer-specific mortality.


RESULTS
The 15-year cumulative incidences of radical prostatectomy and radiotherapy through 2001 were 2.84% and 6.02%, respectively, for Seattle cohort members, compared to 0.56% and 5.07% for Connecticut cohort members (odds ratio 5.20, 95% confidence interval 3.22 to 8.42 for surgery and odds ratio 1.24, 95% confidence interval 0.98 to 1.58 for radiation). The cumulative incidence of androgen deprivation therapy from 1991-2001 was 4.78% for Seattle compared to 6.13% for Connecticut (odds ratio 0.77, 95% confidence interval 0.67 to 0.87). The adjusted rate ratio of prostate cancer mortality through 2001 was 1.02 (95% C.I. 0.96 to 1.09) in Seattle versus Connecticut.


CONCLUSIONS
Among men aged 65 or older, more intensive prostate cancer screening early in the PSA era and more intensive treatment particularly with radical prostatectomy over 15 years of follow-up were not associated with lower prostate cancer-specific mortality.
Lu-Yao
Grace
G
The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Albertsen
Peter C
PC
Stanford
Janet L
JL
Stukel
Therese A
TA
Walker-Corkery
Elizabeth
E
Barry
Michael J
MJ
D000368:Aged; D003237:Connecticut / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011468:Prostatectomy / Q000639:trends; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D018714:Radiotherapy, Adjuvant / Q000639:trends; D018426:SEER Program; D014861:Washington / Q000453:epidemiology
Lancet. 1994 Jan 29;343(8892):251-4
7905093
Arch Intern Med. 2006 Jan 9;166(1):38-43
16401808
J Natl Cancer Inst. 2003 Jul 2;95(13):930-1
12837821
BJU Int. 2004 Apr;93(6):695-701
15049974
BMJ. 2002 Oct 5;325(7367):740
12364300
Stat Med. 1990 Dec;9(12):1501-15
2281238
JAMA. 2006 Dec 13;296(22):2683-93
17164454
J Natl Cancer Inst. 2002 Jul 3;94(13):981-90
12096083
Am J Epidemiol. 2004 Dec 1;160(11):1059-69
15561985
Med Care. 2002 Aug;40(8 Suppl):IV-3-18
12187163
J Natl Cancer Inst. 1999 Jun 16;91(12):1017-24
10379964
N Engl J Med. 2005 May 12;352(19):1977-84
15888698
J Natl Cancer Inst. 2000 Apr 19;92(8):613-21
10772678
J Natl Cancer Inst. 1999 Jun 16;91(12):1025-32
10379965
CA Cancer J Clin. 2006 Jan-Feb;56(1):11-25; quiz 49-50
16449183
Am J Epidemiol. 2006 Aug 15;164(4):376-84
16829552
Epidemiol Rev. 2001;23(1):181-6
11588846