Changing presentation of prostate cancer in a UK population – 10 year trends in prostate cancer risk profiles in the East of England

Abstract

Background:Prostate cancer incidence is rising in the United Kingdom but there is little data on whether the disease profile is changing. To address this, we interrogated a regional cancer registry for temporal changes in presenting disease characteristics.Methods:Prostate cancers diagnosed from 2000 to 2010 in the Anglian Cancer Network (n=21 044) were analysed. Risk groups (localised disease) were assigned based on NICE criteria. Age standardised incidence rates (IRs) were compared between 2000–2005 and 2006–2010 and plotted for yearly trends.Results:Over the decade, overall IR increased significantly (P<0.00001), whereas metastasis rates fell (P<0.0007). For localised disease, IR across all risk groups also increased but at different rates (P<0.00001). The most striking change was a three-fold increase in intermediate-risk cancers. Increased IR was evident across all PSA and stage ranges but with no upward PSA or stage shift. In contrast, IR of histological diagnosis of low-grade cancers fell over the decade, whereas intermediate and high-grade diagnosis increased significantly (P<0.00001).Conclusion:This study suggests evidence of a significant upward migration in intermediate and high-grade histological diagnosis over the decade. This is most likely to be due to a change in histological reporting of diagnostic prostate biopsies. On the basis of this data, increasing proportions of newly diagnosed cancers will be considered eligible for radical treatment, which will have an impact on health resource planning and provision.

Prostate Cancer Disease Characteristics at the Time of Diagnosis and Initial Treatment Offered in a Tertiary Hospital at Ouagadougou (Burkina Faso)

“…The age range at the time of diagnosis of PCa in our study is also commonly reported from West Africa where studies from Ghana [9], Nigeria [10] and Senegal [11] recorded a mean age of 65.4, 66.6 and 65 years respectively. The age of diagnosis of PCa in our study is also similar to those reported from the developed world particularly in Europe and North America [12,13]. However, the majority of PCa cases are diagnosed in patients who are asymptomatic in the developed world due to the widespread use of the Prostate Specific Antigen (PSA) blood test [12][13][14].…”

“…The age of diagnosis of PCa in our study is also similar to those reported from the developed world particularly in Europe and North America [12,13]. However, the majority of PCa cases are diagnosed in patients who are asymptomatic in the developed world due to the widespread use of the Prostate Specific Antigen (PSA) blood test [12][13][14]. 68.7% of PCa cases were diagnosed in the absence of symptoms in the study of Muller [12] from the USA.…”

The Importance of Prostate-specific Antigen (PSA) Nadir and Early Identification of PSA Relapse after 10 Years of Prostate Iodine125 Seed Brachytherapy in Edinburgh

“…There has, however, been a slight increase in the number of intermediate risk patients in cohort 2 due to a shift to Gleason grade 7 tumours. Interestingly, the median PSA values are very similar, suggesting the two groups are similarly matched and the increase in Gleason grade 7 may reflect a change in pathological interpretation of grade, as reported in other studies [8]. There is a distinction however between the two groups in terms of a significant reduction in the use of neoadjuvant hormones pre-implant and a decrease in the number of patients with a D90 <125 Gy, leading to an increase in the median D90 overall for cohort 2.…”

Utilization of Prostate Brachytherapy for Low-Risk Prostate Cancer: Is the Decline Overstated?

“…Others have suggested that outside issues, such as financial reimbursement, lack of physician skill proficiency in brachytherapy, as well as stage migration towards more intermediate and high grade disease, which may be less likely to include prostate brachytherapy, have played a role in this trend [6]. These issues have led to several provocative studies suggesting that prostate brachytherapy is on a steep decline.…”