Prostate cancer. Prevalence and survival in relation to PSA-testing

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1 Prostate cancer Prevalence and survival in relation to PSA-testing Jan Adolfsson, MD, PhD Director Oncological Center Karolinska Institute Stockholm, Sweden

2 Radical prostatectomy Retropubic: antegrade retrograde Seminal vesicle Perineal Prostate

3 Localized prostate cancer

4 Prostate cancer Most common male cancer in the western world 50 yrs and up 50% of 70 yrs old - microscopic lesions risk before age 75 approx 10% in Sweden 9200 new cases per year in Sweden 2600 dead of prostate cancer per year alive with prostate cancer alive and diagnosed within 5 years

5 US Mail 1999

6 Prostate cancer incidence

7 Prostate cancer incidence

8 Cancer in Sweden 2006 National cancer registry, EpC, 2007

9 Cancer in the Stockholm-Gotland region 2006 Incidence (men) Prevalence (men) Prostata Annan tumör i hud Tjocktarm Lunga Urinorgan (exkl njure) 5 Ändtarm, anus 4 Melanom i hud 3 Non-Hodgkin lymfom Okänd primärtumör2 Njure Prostata Annan tumör i hud Urinorgan (exkl njure) Melanom i hud Tjocktarm Ändtarm, anus Testikel Non-Hodgkin lymfom Centrala nervsystemet Njure

10 Prostate cancer US Cancer Statistics Sweden Per Figure F17: Prostate (icd-7:177) Year of diagnosis Males Jemal, CA Cancer J Clin 2007 Cancerregistret, EpC, 2007

11 Prostate specific antigen (PSA) Simple blood test Elevated prostate cancer, inflammatory conditions in the prostate Not diagnostic but indicates biopsy Approx 10% of all men above 50

12 Observed age-standardized rates (Nordic standard 2000) of prostate cancer incidence and mortality in the Nordic countries and the United States (all ages) Kvale, R. et al. J. Natl. Cancer Inst : ; doi: /jnci/djm249 Copyright restrictions may apply.

13 Fitted trends from joinpoint regression (bold lines) versus the observed age-standardized rates (Nordic standard 2000) of prostate cancer incidence and mortality in four of the five Nordic countries for all ages maps/nordic/ Kvale, R. et al. J. Natl. Cancer Inst : ; doi: /jnci/djm249 Copyright restrictions may apply.

14 Prostate cancer in Sweden NPCR Percent 20 Percent 20 Ag- standardized rate per men Ag- standardized rate per men T1a+T1bT1c T2 T3-T4 Other T1a+T1bT1c T2 T3-T4 Other Adolfsson et al, Scand J Urol Nephrol, 41:456, 2007

15 Stockholm-Gotland region 2006 Relative survival all cancer (men) Relative survival prostate cancer 1,0 0,9 1,0 0,9 0,8 Kumulativ överlevnad 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0, (47%) (52%) (61%) (67%) År Relativ överlevnad i cancer för män i Stockholm- Gotlandregionen. Uppdelning i fyra diagnosårsklasser. 5-års överlevnad inom parentes. Uppföljning till Kumulativ överlevnad 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0, (65% ) (70% ) (82% ) (90% ) Å r R e la tiv ö ve rle vn a d i p ro sta ta ca n cer fö r m ä n i S to ck h o lm - G o tla n d re g io n e n. U p p d e ln in g i fyra d ia g n o så rskla s se r. 5 -å rs ö ve rle vn a d i p a re n te s. U p p fö ljn in g dx PSA dx clin death Regional Cancer Register, Stockholm/Gotland, 2007

16 Swedish population 2003 Fi gur 1c. Bef ol kni ng i f emår s ål der sgr upper f ör r i ket 2003 Män Kvi nnor Estimated 2030 Fi gur 1d. Bef ol kni ng i f emår s ål der sgr upper f ör r i ket 2030 Män Kvi nnor

17 Swedish population estimated SCB, 2003

18 Estimated new cancer cases in Sweden up to 2030 Fi gur 2b. Ant al f al l av cancer f ör r i ket män kvi nnor Pop Pop+dis Den framtida ohälsan, Ahlbom, Adolfsson et al 2004

19 Estimated new cases of prostate caner in Sweden up to pc Linje Den framtida ohälsan, Ahlbom, Adolfsson et al 2004

20 Conditions (WHO) required for screening Prostate cancer Disease Significant for individual and society yes Possible to find presymptomatic yes Test Effective yes Acceptable for individual and society yes Treatment Effective yes? More effective in preclinical phase? Ethics Over treatment yes, extent? More good than harm - Primum non nocere? ERSPC, PLCO

21 Prostate cancer Prevalence and survival in relation to PSA-testing More cases, younger, smaller tumors Decreased mortality (?) Increased survival (may largely be an artifact) New cases / dead of prostate cancer 3.5/1 Awaiting two large screening trials No formal service screening in the world

22

23 Dödsorsaksregistret, EpC, 2007

24 Per Figure F17: Prostate (icd-7:177) Cancer i Sverige Year of diagnosis Males 160 Per Figure F13: Breast (icd-7:170) Year of diagnosis Females Cancerregistret, EpC, 2007

25 Relative survival in the NPCR Relative survival Metastatic disease ( n = ) Localised: PSA < 20, age < 75 ( n = ) All patients ( n = ) Time (years) Adolfsson et al, Scand J Urol Nephrol, 41:456, 2007

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