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.
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