Prostate cancer changes in clinical presentation and treatments in two decades: an Italian population-based study.
The incidence of prostate cancer is on the rise in many industrialised countries, including Italy, most likely because of the spread of PSA testing. In Italy, prostate cancer mortality has been dropping since 2000, but it is difficult to understand whether PSA testing is the main reason, considering the role of treatment in prognosis. The objectives of this study were: (1) to describe Italian trends of prostate cancer risk categories and corresponding changes in treatment patterns and (2) to interpret changes in survival over time.



We made a retrospective observational study using population-based cancer registries. We examined two periods, 1996-1999 and 2005-2007, analysing the distribution of patients among risk groups and treatment changes in those intervals. We estimated 7- and 15-year relative survival with the cohort approach, Ederer II method. We analysed 4635 cases.



There was downward risk migration from the first to the second period. In patients younger than 75 years, there was an increase in radical prostatectomy but not radiotherapy; patients older than 75 years rarely had treatment with radical intent. We noted an improvement of prostate cancer survival in the high-risk group.



These findings raise several questions: the possible overtreatment of low-risk patients undergoing radical treatment; the utility of more aggressive treatment for elderly patients with high-risk disease; and the importance of a multidisciplinary clinical approach to ensure multiple and alternative treatment options. The increase in survival, with the decrease in mortality, suggests an effect of radical treatments on prognosis.
Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy. Electronic address: annalisa.trama@istitutotumori.mi.it.
Annalisa
A
Trama
Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy. Electronic address: laura.botta@istitutotumori.mi.it.
Laura
L
Botta
Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy. Electronic address: nicola.nicolai@istitutotumori.mi.it.
Nicola
N
Nicolai
Interinstitutional Epidemiology Unit, AUSL Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy; Arcispedale S. Maria Nuova, IRCCS Reggio Emilia, Viale Umberto I 50, 42123 Reggio Emilia, Italy. Electronic address: paolo.giorgirossi@ausl.re.it.
Paolo Giorgi
PG
Rossi
Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy. Electronic address: paolo.contiero@istitutotumori.mi.it.
Paolo
P
Contiero
Registro Tumori Asl Napoli 3 Sud, Piazza San Giovanni, 80031 Brusciano, NA, Italy. Electronic address: mariofusco2@virgilio.it.
Mario
M
Fusco
Department of Urology, Central Hospital of Bolzano, Via Loren Boeler 5, 39100 Bolzano, Italy. Electronic address: mlodde@hotmail.com.
Michele
M
Lodde
Registro Tumori della Provincia di Latina, Viale P. Nervi, Centro Latina Fiori, 04100 Latina, Italy. Electronic address: fpannozzo@ausl.latina.it.
Fabio
F
Pannozzo
Servizio epidemiologia clinica e valutativa, Registro Tumori della Provincia di Trento, viale Verona, 38100 Trento, Italy. Electronic address: Silvano.Piffer@apss.tn.it.
Silvano
S
Piffer
Registro Tumori Ligure, Epidemiologia Clinica IRCCS AOU San Martino, IST Genova Largo Rosanna Benzi 10, 16132 Genoa, Italy. Electronic address: antonella.puppo@hsanmartino.it.
Antonella
A
Puppo
Department for Haematology and Oncology, Tyrolean Cancer Research Institute, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. Electronic address: andreas.seeber@tirol-kliniken.at.
Andreas
A
Seeber
Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, ASP Via Dante 109, Ragusa, Italy. Electronic address: rtumino@tin.it.
Rosario
R
Tumino
Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; Prostate Cancer Program and Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy. Electronic address: riccardo.valdagni@istitutotumori.mi.it.
Riccardo
R
Valdagni
Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy. Electronic address: gemma.gatta@istitutotumori.mi.it.
Gemma
G
Gatta
D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000639:trends*; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D011878:Radiotherapy / Q000639:trends*; D012189:Retrospective Studies
D000726:Androgen Antagonists
Clinical presentation; Population-based cancer registries; Prostate cancer; Survival; Treatments