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
N1 - Copyright © 2017 Elsevier Ltd. All rights reserved.
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
JF - European Journal of Cancer
ER -
