Diagnostic Age, Age at Death and Stage Migration in Men Dying with or from Prostate Cancer in Denmark

Abstract

The impact of changes in diagnostic activity and treatment options on prostate cancer epidemiology remains a subject of debate. Newly published long-term survival outcomes may not represent contemporary patients and new perspectives are in demand. All men dying in Denmark with prostate cancer diagnosis during a 10-year period were analyzed to address the stage migration of and time lived with prostate cancer diagnosis. All male deaths in Denmark between 2007 and 2016 (n = 261,657) were obtained and crosslinked with The Danish Prostate Cancer Registry (DaPCaR) and the Danish Cancer Registry. Correlation in diagnostic age and stage (localized, locally advanced, metastatic), age at death and cause of death were investigated by Kruskal-Wallis test and linear regression in 15,692 men diagnosed with prostate cancer. Prostate cancer mortality remained stable during the study period. Among the men who died of prostate cancer, 65% had locally advanced or metastatic disease at diagnosis. Age at diagnosis declined in men diagnosed with localized disease and remained constant in men with locally advanced or metastatic disease. Age at death increased in all men. Despite increased efforts to detect prostate cancer early, two-thirds of men who die from prostate cancer still have advanced prostate cancer at the time of diagnosis. Our data show increased life-expectancy in men diagnosed with prostate cancer, however, this benefit must be weighed against increased time of living with the disease and overdiagnosis. The intensified treatment of elderly men and men with advanced disease may be the key to lower prostate cancer mortality.

Critical survival periods in prostate cancer in Sweden explored by conditional survival analysis

“…10 Similarly, in Denmark between 2007 and 2016 the underlying cause of death in PC patients was PC for 53% of men. 11 Among men who died of PC, 35.5% were diagnosed with localized, 29.0% with locally advanced and 35.5% with M1 PC; among men with other causes of death the proportions were 65.1%, 22.6%, and 12.3%. 11 The traditional treatment for metastatic PC has been androgen deprivation therapy (ADT) and for castrationresistant tumors several new therapeutic options have become available from about 2010 to 2020 as discussed in terms of the national treatment guidelines.…”

“…11 Among men who died of PC, 35.5% were diagnosed with localized, 29.0% with locally advanced and 35.5% with M1 PC; among men with other causes of death the proportions were 65.1%, 22.6%, and 12.3%. 11 The traditional treatment for metastatic PC has been androgen deprivation therapy (ADT) and for castrationresistant tumors several new therapeutic options have become available from about 2010 to 2020 as discussed in terms of the national treatment guidelines. 12 The novel agents include docetaxel, abiraterone, enzalutamide, cabazitaxel, sipuleucel-T, radium-223, and others but as the present follow-up terminated in 2018 the novel therapies may impact survival only towards the end of the study or not at all.…”

“…For Swedish men who died between years 1987 and 2006 and had a PC diagnosis, 50% died of PC while the underlying cause of death for the other 50% was a non‐PC cause 10 . Similarly, in Denmark between 2007 and 2016 the underlying cause of death in PC patients was PC for 53% of men 11 . Among men who died of PC, 35.5% were diagnosed with localized, 29.0% with locally advanced and 35.5% with M1 PC; among men with other causes of death the proportions were 65.1%, 22.6%, and 12.3% 11 …”

“… 10 Similarly, in Denmark between 2007 and 2016 the underlying cause of death in PC patients was PC for 53% of men. 11 Among men who died of PC, 35.5% were diagnosed with localized, 29.0% with locally advanced and 35.5% with M1 PC; among men with other causes of death the proportions were 65.1%, 22.6%, and 12.3%. 11 …”

“… 11 Among men who died of PC, 35.5% were diagnosed with localized, 29.0% with locally advanced and 35.5% with M1 PC; among men with other causes of death the proportions were 65.1%, 22.6%, and 12.3%. 11 …”