[1061] PSA Screening and Deaths from Prostate Cancer after Diagnosis; a Population Based Analysis

Mitchell S Wachtel, Allan L Haynes, Jr., Scott Dahlbeck, Werner de Riese. Texas Tech University Health Sciences Center, Lubbock, TX; Texas Tech University, Lubbock, TX

Background: The United States Preventative Health Task Force recently recommended prostate specific antigen (PSA) screening be abandoned. Prior analyses of Surveillance, Epidemiology, and End Results (SEER) data lacked 10 y follow-up, recommended due to the diseases' slow progression, to determine the decline in incidence based mortality. We hypothesized 1983-2009 SEER data might better assess a 1991-1990 decline in prostate cancer death using a 10 y followup.
Design: SEER*stat 7.0.9 obtained via SEER rate sessions annual age-adjusted incidence rates and standard errors (SE) for histologically proven prostatic adenocarcinoma among men 40-84 y lacking prior cancer diagnosis with ≥ 1 month follow-up. 1983-2009 estimates were obtained for prostate cancer diagnoses overall, with loco-regional spread (LR), and with distant (D2) spread. 1983-1999 estimates were obtained for prostate cancer diagnoses with associated prostate cancer deaths within 10 years of diagnosis (incidence based mortality). Joinpoint Regression Program 3.5.3, using Hudson's method, fit log-linear models to estimate joinpoints and average annual percentage changes (APC), calculated SE and confidence intervals (CI), and performed tests of parallelism.
Results:

Tests for parallelism showed racial APC differences as respects prostate cancer diagnoses in general (P<0.05), incidence based mortality (P<0.05), and LR spread (P<0.05), but not D2 spread (P>0.05). All analyses identified a 1991-1993 joinpoint, previously demonstrated to have been related to PSA screening implementation. For 1991-1999, tests for parallelism failed to show White (W) (P>0.05) or Black (B) (P>0.05) APC differences between D2 spread and incidence based mortality. On average, incidence based mortality declined each year between 1991-1999. for Whites, 10.9%, for Blacks, 11.6%.
Conclusions: Incidence based mortality declined by about 10% per year between 1991-1999, with similar changes in D2 spread. This provides evidence that PSA screening saved lives by early detection.
Category: Genitourinary (including renal tumors)

Monday, March 4, 2013 1:45 PM

Proffered Papers: Section A, Monday Afternoon

 

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