Historical Prostate Cancer Screening and Treatment Outcomes from a Single Institution

Abstract

Objective: To quantify outcomes of individuals diagnosed and treated for prostate cancer in a single institution. Design: Retrospective electronic chart abstraction.Setting: Marshfield Clinic, the largest private multispecialty group practice in Wisconsin, and one of the largest in the United States, provides health care services annually to approximately 385,000 unique patients through 1.8 million annual patient encounters.Participants: Individuals within the Marshfield Clinic cancer registry who had been diagnosed with prostate cancer between 1960 and 2009. Methods:Electronic chart abstraction from the cancer registry and the electronic medical record was conducted (N=6,181). Data abstracted included age at diagnosis; stage and grade of tumor; prostate specific antigen (PSA) values before, at, and after diagnosis; initial cancer treatment; follow-up time; subsequent cancer treatments; evidence of metastasis; age of death; and cause of death, if known. Results:The average age of prostate cancer diagnosis has decreased from 70-71 years in the 1960's and 1970's to an average age at diagnosis of 67 years in the 2000's (P<0.001). This decrease in age occurred within the decades of implementation of PSA screening. Approximately 74% of men diagnosed with prostate cancer within the PSA screening era had at least one PSA test, and the presence of a PSA test did not appear to change treatment outcome. Age, grade, and stage were the biggest predictors of prostate cancer outcome. There was no difference in event-free survival between current treatment types (radical prostatectomy, brachytherapy, photon treatment, or intensity-modulated radiation therapy) (2003 or later) when stratified by age (greater than 85%, 5-year event-free survival P=0.85); however, more events occurred with older external beam radiation treatment regimens (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)) (70% to 75%, 5-year event-free survival P=0.001).Conclusion: Individuals diagnosed and treated for prostate cancer within the Marshfield Clinic comprehensive care setting follow national trends with a decreased age of diagnosis since the advent of PSA screening. Outcomes for individuals treated within the Clinic system are also comparable to national trends.

Current Status of Biomarkers for Prostate Cancer

“…Furthermore, PSA does not distinguish between stages of PCa and, significantly, does not identify metastatic PCa with the sensitivity and specificity required to make accurate therapeutic decisions [14]. Since the implementation of PSA screening among the ageing population, it has reduced the average age of PCa diagnosis from 70 to 71 years of age to 67 years of age [15]. The widespread use of PSA as a screening tool has been partly responsible for the rapid increase in PCa diagnoses in the past two decades.…”

Molecular Biological Factors in the Prediction of Prostate Cancer

“…Некоторые исследователи предложили рассмотреть GRN-A в качестве прогностического и диагностического маркера РПЖ, так как последний секретируется клетками предстательной железы [13]. Недостаток применения CGA как биомаркера заключается в том, что нейроэндокринные клетки присутствуют не во всех гистологических вариантах РПЖ и не способны выявляться на самой ранней стадии [3]. В случае первично-локализованного РПЖ хромо-гранин является неблагоприятным прогностиче-ским маркером биохимического рецидива [14].…”

“…С момента внедрения простатспецифического антигена (ПСА) в качестве скринингового маркера отмечается рост числа диагнозов РПЖ. Однако повысилась и частота ложноположительного РПЖ [3]. Наиболее важной проблемой использования ПСА в качестве онкомаркера является относительно невысокая раковая специфичность, что обусловлено его по-вышением при доброкачественной гиперплазии предстательной железы (ДГПЖ), инфекции или хроническом простатите [4].…”

Heart healthy equals prostate healthy and statins, aspirin, and/or metformin (S.A.M.) are the ideal recommendations for prostate cancer prevention

“… 120 127 More than 2200 Americans die of CVD each day, over 800 000 per year, and 150 000 of these individuals are < 65 years of age, 127 which is still lower than the average age of a prostate cancer diagnosis. 128 Therefore, while the debate over PSA screening continues, 129 130 so will the urgent need to place risk in perspective and highlight less recognized observations from these same pieces of controversial data. For example, the notable PLCO U.S. PSA screening trial which was the major impetus for the U.S. Preventive Services Task Force to recently discourage PSA screening, 129 130 followed an impressive 76 693 men in 10 U.S. study centers.…”