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

Abstract

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.

Circulating Tumor DNA Abundance and Potential Utility in De Novo Metastatic Prostate Cancer

“…De novo metastatic disease represents 5-10% of prostate cancer (PCa) diagnoses but contributes to almost 50% of PCa related deaths [1,2]. The incidence of de novo metastatic diagnosis is rising, potentially related to improved imaging modalities and decreased prostate specific antigen (PSA) screening [3,4].…”

Cancer Prevention and Control: Then and Now

“…The PSA test was developed to detect metastatic recurrence in prostate cancer patients, but in the 1980s, the PSA test was rapidly adopted as a screening test without evidence that it reduced mortality from prostate cancer. This led to an explosion in the number of prostate cancers diagnosed each year, peaking in 1992 [8,9]. Ultimately, it was recognized that the PSA test identifi ed a reservoir of indolent prostate cancers whose early detection and treatment did not decrease mortality.…”

“…Ultimately, it was recognized that the PSA test identifi ed a reservoir of indolent prostate cancers whose early detection and treatment did not decrease mortality. Prostate cancer screening guidelines have since been revised, and recommendations for PSA screening are much more limited to populations at increased risk [8,9]. This was one of the earliest examples of an "over diagnosis of cancer", in which screening detects nonlethal, early cancers.…”

Prostate cancer screening: And the pendulum swings

“…In this issue of Cancer , Helgstrand and colleagues present a unique assessment of the prostate cancer screening question. For more than 25 years, the medical profession, especially in the United States, has struggled with the issue.…”

“…Helgstrand and colleagues present an ecological study comparing prostate cancer outcomes between similar populations from 2 different health care environments; the United States, where screening started 10 to 15 years earlier, and Denmark, where screening is less popular even today . The size of the populations are such that this is an effectiveness study.…”