Nationwide, population-based study of prostate cancer stage migration between and within clinical risk categories

Ohmann, Erin; Loeb, Stacy; Robinson, David; Bill‐Axelson, Anna; Berglund, Anders; Stattin, Pär

doi:10.3109/21681805.2014.892150

Cited by 27 publications

(18 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, we found that patients with high-risk disease treated with radical prostatectomy had a lower PSA level at diagnosis, as well as a lower rate of locally advanced disease and a higher rate of high grade prostate cancer over time. Changes in PSA level and clinical stage at diagnosis were to be expected after the introduction of PSA screening programmes; similar results were shown in a recent population-based study [19]. Moreover, such results confirmed previous studies that showed a stage migration towards more aggressive prostate cancer for patients treated with radical prostatectomy [11][12][13].…”

Section: Discussionsupporting

confidence: 89%

Impact of stage migration and practice changes on high‐risk prostate cancer: results from patients treated with radical prostatectomy over the last two decades

et al. 2015

View full text Add to dashboard Cite

Background Phenotype of prostate cancer at diagnosis has changed through the years. We aim to evaluate the impact of year of surgery on clinical, pathologic and oncologic outcomes of high-risk prostate cancer patients. Patients and methods We evaluated 1,033 clinically high-risk patients, defined as the presence of at least one of the following risk factors: pre-operative prostate specific antigen (PSA) level >20 ng/ml, and/or clinical stage ≥T3, and/or biopsy Gleason score ≥8. Patients were treated between 1990 and 2013 at a single Institution. Year-per-year trends of clinical and pathologic characteristics were examined. Multivariable Cox regression analysis was used to test the relationship between year of surgery and oncologic outcomes. Results We observed a decrease over time in the proportion of high-risk patients with a pre-operative PSA level >20 ng/ml or clinical stage cT3. An opposite trend was seen for biopsy Gleason score ≥8. We observed a considerable increase in the median number of lymph nodes removed that was associated with an increased rate of LNI. At multivariable Cox regression analysis, year of surgery was associated with a reduced risk of biochemical recurrence (HR per 5-year: 0.90; 95% CI: 0.84–0.96; p=0.01) and distant metastasis (HR per 5-year: 0.91; 95% CI: 0.83–0.99; p=0.039), after adjusting for age, pre-operative PSA, pathologic stage, lymph node invasion, surgical margin status, and pathological Gleason score. Conclusions In this single center study, an increased diagnosis of localized and less extensive high-grade prostate cancer was observed over the last two decades. High-risk patients selected for radical prostatectomy showed better cancer control over time. Better definitions of what constitutes high-risk prostate cancer among contemporary patients are needed.

show abstract

Section: Discussionsupporting

confidence: 89%

Impact of stage migration and practice changes on high‐risk prostate cancer: results from patients treated with radical prostatectomy over the last two decades

et al. 2015

View full text Add to dashboard Cite

show abstract

“…In Denmark, PSA‐based early detection programs have never been recommended; however, laboratory data and trends in the incidence of PCa suggest that the use of PSA testing increased in the early 2000s . Although the effect of PSA‐based early detection on PCa‐specific mortality is still under debate, early detection has significantly increased the number of men diagnosed with localized and locally advanced disease . Randomized clinical trials (RCTs) investigating PSA‐screening have demonstrated a reduction in the incidence of de novo metastatic PCa, but this has not been investigated in large, population‐based studies …”

Section: Introductionmentioning

confidence: 99%

Trends in incidence and 5‐year mortality in men with newly diagnosed, metastatic prostate cancer—A population‐based analysis of 2 national cohorts

Helgstrand

Røder

Klemann

et al. 2018

Cancer

View full text Add to dashboard Cite

Despite earlier detection, de novo metastatic PCa remains associated with a high risk of 5-year disease-specific mortality. The reduced 5-year PCa mortality in the Danish cohort is largely explained by lead-time. Early detection strategies do indeed decrease the incidence of de novo metastatic PCa, as observed in the SEER cohort. This achievement, however, must be weighed against the unsolved issue of overdetection and overtreatment of indolent PCa. Cancer 2018;124:2931-8. © 2018 American Cancer Society.

show abstract

“…The extensive use of PSA testing in Sweden also likely explain differences in clinical presentation and survival between the two otherwise similar Nordic countries with free public healthcare systems [11,12]. Almost 30% of men diagnosed with PCa in Sweden in 2011 were classified as low-risk while 11% had metastases at diagnosis [13] corresponding percentages in the current Danish cohort was 18% and 17%. In accordance with observations from Sweden and also USA, we found that treatment with curative intent was primarily used in men with clinically localized PCa, whereas men with higher risk disease were managed without curative intent [11,14].…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and primary management of patients diagnosed with prostate cancer between 2007 and 2013: status from a Danish primary referral center

et al. 2016

Self Cite

View full text Add to dashboard Cite

Background: The Danish Cancer Registry holds information on all prostate cancers (PCa) cases, including diagnostic TNM. However, stratification according to contemporary risk classification is not possible because histopathological grading and prostate-specific antigen (PSA) level are not registered. The objective of the study was to report clinical characteristics and primary management of men diagnosed with PCa from a primary referral center in Denmark. Material and methods: Records on all men diagnosed with PCa at the Department of Urology, Frederiksberg Hospital, 1 January 2007 -31 December 2013, were reviewed. Clinical characteristics and primary treatment were recorded. The National Comprehensive Cancer Network risk group classification was used. Results: A total of 1934 men with a median age of 69 years (interquartile range 65-75) were diagnosed with PCa in the study period resulting in an incidence rate (World Standard Population) of 84/100 000. Overall, 18% were classified as low-risk, 34% as intermediate-risk, 23% as high-risk, 8% as very high-risk and 17% had metastatic disease at diagnosis. Among men age <65 years 70% had low-or intermediate-risk disease, while this was the case for 58% of men aged 65-75 and 22% of men aged >75. Metastatic disease was found in 11% of men <65 years, 17% of men 65-75 years and 23% of men >75 years. In total 73% of men with low-risk PCa were managed on watchful waiting or active surveillance. Curatively intended treatment was performed in 56% of men with intermediate-risk and 61% of men with high-risk PCa, while hormonal therapy was used in 90% of men with very high-risk and 98% of men with metastatic PCa. Conclusion: In a population without systematic PSA testing we found a large proportion of patients presenting with advanced PCa at diagnosis. Elderly patients presented with more advanced disease. Curative treatment was primarily used in younger men with clinically localized PCa.

show abstract

Nationwide, population-based study of prostate cancer stage migration between and within clinical risk categories

Abstract: Low-risk cases today have substantially lower tumor volume and PSA levels than low-risk cases diagnosed in 1998, indicating that outcomes in studies that recruited cases in previous decades represent worst case scenarios.

Cited by 27 publications

References 21 publications

Impact of stage migration and practice changes on high‐risk prostate cancer: results from patients treated with radical prostatectomy over the last two decades

Impact of stage migration and practice changes on high‐risk prostate cancer: results from patients treated with radical prostatectomy over the last two decades

Trends in incidence and 5‐year mortality in men with newly diagnosed, metastatic prostate cancer—A population‐based analysis of 2 national cohorts

Clinical characteristics and primary management of patients diagnosed with prostate cancer between 2007 and 2013: status from a Danish primary referral center

Contact Info

Product

Resources

About