Diagnostic characteristics of lethal prostate cancer

John Thomas Helgstrand; Martin Andreas Røder; Nina Klemann; Birgitte Grønkær Toft; Klaus Brasso; Ben Vainer; Peter Iversen

doi:10.1016/j.ejca.2017.07.007

Diagnostic characteristics of lethal prostate cancer

John Thomas Helgstrand, Martin Andreas Røder, Nina Klemann, Birgitte Grønkær Toft, Klaus Brasso, Ben Vainer, Peter Iversen

Institut for Klinisk Medicin

13 Citationer (Scopus)

Abstract

Background The diagnostic characteristics of men who eventually die from prostate cancer (PCa) and the extent to which early diagnostic strategies have affected these characteristics are unclear. We aimed to investigate trends in survival and clinical presentation at diagnosis in men who eventually died from PCa. Patients and methods Based on the national database, the Danish Prostate Cancer Registry, a nationwide population-based study of all 19,487 men who died from PCa in Denmark between 1995 and 2013 was conducted. Trends in median survival and trends in age, prostate-specific antigen (PSA), clinical stage, and Gleason score (GS) at diagnosis were analysed. Results A total of 46.9%, 16.8%, and 36.3% had metastatic (M+), locally advanced/lymph node positive (LaN+), and localised disease, respectively, at diagnosis. Only 0.15% had localised disease, GS ≤ 6 and PSA<10. Over time, the proportion of men with M+ disease at diagnosis decreased from 54.0–38.3% (p < 0.0001), whereas the proportion LaN + disease increased from 8.6–27.3% (p < 0.0001). The proportion of localised disease remained stable at 33.2–41.9%. Median survival increased 2.11 years from 1.88 (95% CI: 1.68–2.08) in 1995 to 3.99 (95% CI: 3.71–4.28) years in 2013, p < 0.0001. Conclusions In a large population-based study, the results confirmed concurrent literature that the majority of men who eventually died from PCa had LaN+ or M+ disease at diagnosis. The proportion of men with M+ disease at diagnosis decreased significantly over time, parallelled by an increase in median survival. Taken together, this indicates a lead-time effect on survival, which presently, however, is not substantial enough to result in a reduced PCa-specific mortality.

Originalsprog	Engelsk
Tidsskrift	European Journal of Cancer
Vol/bind	84
Sider (fra-til)	18-26
Antal sider	9
ISSN	0959-8049
DOI	https://doi.org/10.1016/j.ejca.2017.07.007
Status	Udgivet - okt. 2017

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10.1016/j.ejca.2017.07.007

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@article{fd4ca6f2621a481db94e71c8aa8ab973,

title = "Diagnostic characteristics of lethal prostate cancer",

abstract = "Background The diagnostic characteristics of men who eventually die from prostate cancer (PCa) and the extent to which early diagnostic strategies have affected these characteristics are unclear. We aimed to investigate trends in survival and clinical presentation at diagnosis in men who eventually died from PCa. Patients and methods Based on the national database, the Danish Prostate Cancer Registry, a nationwide population-based study of all 19,487 men who died from PCa in Denmark between 1995 and 2013 was conducted. Trends in median survival and trends in age, prostate-specific antigen (PSA), clinical stage, and Gleason score (GS) at diagnosis were analysed. Results A total of 46.9%, 16.8%, and 36.3% had metastatic (M+), locally advanced/lymph node positive (LaN+), and localised disease, respectively, at diagnosis. Only 0.15% had localised disease, GS ≤ 6 and PSA<10. Over time, the proportion of men with M+ disease at diagnosis decreased from 54.0–38.3% (p < 0.0001), whereas the proportion LaN + disease increased from 8.6–27.3% (p < 0.0001). The proportion of localised disease remained stable at 33.2–41.9%. Median survival increased 2.11 years from 1.88 (95% CI: 1.68–2.08) in 1995 to 3.99 (95% CI: 3.71–4.28) years in 2013, p < 0.0001. Conclusions In a large population-based study, the results confirmed concurrent literature that the majority of men who eventually died from PCa had LaN+ or M+ disease at diagnosis. The proportion of men with M+ disease at diagnosis decreased significantly over time, parallelled by an increase in median survival. Taken together, this indicates a lead-time effect on survival, which presently, however, is not substantial enough to result in a reduced PCa-specific mortality.",

keywords = "Aged, Aged, 80 and over, Cause of Death, Databases, Factual, Denmark, Early Detection of Cancer, Humans, Incidence, Kallikreins, Kaplan-Meier Estimate, Lymphatic Metastasis, Male, Neoplasm Grading, Neoplasm Invasiveness, Neoplasm Staging, Predictive Value of Tests, Prostate-Specific Antigen, Prostatic Neoplasms, Registries, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Journal Article",

author = "Helgstrand, {John Thomas} and R{\o}der, {Martin Andreas} and Nina Klemann and Toft, {Birgitte Gr{\o}nk{\ae}r} and Klaus Brasso and Ben Vainer and Peter Iversen",

year = "2017",

month = oct,

doi = "10.1016/j.ejca.2017.07.007",

language = "English",

volume = "84",

pages = "18--26",

journal = "European Journal of Cancer, Supplement",

issn = "0959-8049",

publisher = "Pergamon",

}

TY - JOUR

T1 - Diagnostic characteristics of lethal prostate cancer

AU - Helgstrand, John Thomas

AU - Røder, Martin Andreas

AU - Klemann, Nina

AU - Toft, Birgitte Grønkær

AU - Brasso, Klaus

AU - Vainer, Ben

AU - Iversen, Peter

PY - 2017/10

Y1 - 2017/10

N2 - Background The diagnostic characteristics of men who eventually die from prostate cancer (PCa) and the extent to which early diagnostic strategies have affected these characteristics are unclear. We aimed to investigate trends in survival and clinical presentation at diagnosis in men who eventually died from PCa. Patients and methods Based on the national database, the Danish Prostate Cancer Registry, a nationwide population-based study of all 19,487 men who died from PCa in Denmark between 1995 and 2013 was conducted. Trends in median survival and trends in age, prostate-specific antigen (PSA), clinical stage, and Gleason score (GS) at diagnosis were analysed. Results A total of 46.9%, 16.8%, and 36.3% had metastatic (M+), locally advanced/lymph node positive (LaN+), and localised disease, respectively, at diagnosis. Only 0.15% had localised disease, GS ≤ 6 and PSA<10. Over time, the proportion of men with M+ disease at diagnosis decreased from 54.0–38.3% (p < 0.0001), whereas the proportion LaN + disease increased from 8.6–27.3% (p < 0.0001). The proportion of localised disease remained stable at 33.2–41.9%. Median survival increased 2.11 years from 1.88 (95% CI: 1.68–2.08) in 1995 to 3.99 (95% CI: 3.71–4.28) years in 2013, p < 0.0001. Conclusions In a large population-based study, the results confirmed concurrent literature that the majority of men who eventually died from PCa had LaN+ or M+ disease at diagnosis. The proportion of men with M+ disease at diagnosis decreased significantly over time, parallelled by an increase in median survival. Taken together, this indicates a lead-time effect on survival, which presently, however, is not substantial enough to result in a reduced PCa-specific mortality.

AB - Background The diagnostic characteristics of men who eventually die from prostate cancer (PCa) and the extent to which early diagnostic strategies have affected these characteristics are unclear. We aimed to investigate trends in survival and clinical presentation at diagnosis in men who eventually died from PCa. Patients and methods Based on the national database, the Danish Prostate Cancer Registry, a nationwide population-based study of all 19,487 men who died from PCa in Denmark between 1995 and 2013 was conducted. Trends in median survival and trends in age, prostate-specific antigen (PSA), clinical stage, and Gleason score (GS) at diagnosis were analysed. Results A total of 46.9%, 16.8%, and 36.3% had metastatic (M+), locally advanced/lymph node positive (LaN+), and localised disease, respectively, at diagnosis. Only 0.15% had localised disease, GS ≤ 6 and PSA<10. Over time, the proportion of men with M+ disease at diagnosis decreased from 54.0–38.3% (p < 0.0001), whereas the proportion LaN + disease increased from 8.6–27.3% (p < 0.0001). The proportion of localised disease remained stable at 33.2–41.9%. Median survival increased 2.11 years from 1.88 (95% CI: 1.68–2.08) in 1995 to 3.99 (95% CI: 3.71–4.28) years in 2013, p < 0.0001. Conclusions In a large population-based study, the results confirmed concurrent literature that the majority of men who eventually died from PCa had LaN+ or M+ disease at diagnosis. The proportion of men with M+ disease at diagnosis decreased significantly over time, parallelled by an increase in median survival. Taken together, this indicates a lead-time effect on survival, which presently, however, is not substantial enough to result in a reduced PCa-specific mortality.

KW - Aged

KW - Aged, 80 and over

KW - Cause of Death

KW - Databases, Factual

KW - Denmark

KW - Early Detection of Cancer

KW - Humans

KW - Incidence

KW - Kallikreins

KW - Kaplan-Meier Estimate

KW - Lymphatic Metastasis

KW - Male

KW - Neoplasm Grading

KW - Neoplasm Invasiveness

KW - Neoplasm Staging

KW - Predictive Value of Tests

KW - Prostate-Specific Antigen

KW - Prostatic Neoplasms

KW - Registries

KW - Retrospective Studies

KW - Risk Assessment

KW - Risk Factors

KW - Time Factors

KW - Treatment Outcome

KW - Journal Article

U2 - 10.1016/j.ejca.2017.07.007

DO - 10.1016/j.ejca.2017.07.007

M3 - Journal article

C2 - 28779631

SN - 0959-8049

VL - 84

SP - 18

EP - 26

JO - European Journal of Cancer, Supplement

JF - European Journal of Cancer, Supplement

ER -

Diagnostic characteristics of lethal prostate cancer

Abstract

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