American Cancer Society 2009

Transcription

1 Prostate Cancer: Current Status & Future Directions Unique Impact on Caribbean and African American Men Epidemiology of Prostate Cancer Glen W. McWilliams, MD Chief of Urology James J. Peters Veterans Affairs Medical Center Assistant Professor of Clinical Urology Mount Sinai School of Medicine American Cancer Society 2009 Most common cancer in American men (skin) Second leading cause of cancer death (lung) 192,280 newly diagnosed cases 27,360 deaths 1 in 6 men diagnosed in his lifetime ~ 2 million US men living CaP 1 in 35 will die 10% cancer-related deaths in men

2 Relative Survival Rates American Cancer Society year 100% 10 year 91% 15 year 76% Family History 1st degree relative affected relative at early age more than doubles 2.5, 5, 11 fold Affected father Affected brother

3 Rare before 40 Age Majority screening last decade men >50 2/3 case diagnosed over 65 SEER Data Age Adjusted Incidence per 100,000 men Median Age at diagnosis 68 Age Percentage

4 SEER Cancer Incidence with associated Annual Percentage Change for CaP Trend Period SEER Data Age Adjusted Mortality 25.6 per 100,000 men Median Age at Death 80 Age Percentage

5 SEER US Cancer Mortality with Annual Percentage Change for CaP Trend Period Race and Ethnicity African-American men (AAM) highest incidence > African American men (AAM) highest incidence > White > Hispanic/Latino > Asian-American AAM more likely to be diagnosed Higher PSA Higher tumor volume Advanced stage Receive less aggressive therapy Higher recurrence rates Earlier failure AAM~ twice the mortality risk

6 Age Adjusted Incidence by Race SEER data Race/Ethnicity All Races Black White Hispanic Asian/Pacific Islander 91.1 American Indian/Alaska 76.1 Native Male per 100, men Prostate Cancer Incidence Peak : AAM 342/100,000 EAM 238/100,000 AAM EAM 1980s

7 Age Adjusted Mortality by Race SEER data Race/Ethnicity All Races 25.6 Black 56.3 White 23.6 Hispanic 19.6 Asian/Pacific Islander 10.6 American Indian/Alaska 20.0 Native Male per 100, men Prostate Cancer Mortality Mortality rates in AAM two fold greater than EAM Age Adjusted Rates/100k Period AAM EAM

8 Nationality Most common North America, northwestern Europe, Australia and Caribbean Islands AAM, Caribbean and West Africa (Ghana and Nigeria) Less common in Asia, Africa, Central America and South America Screening differences Lifestyle Asians < Asian Americans < white Americans Prostate Cancer Incidence in Black Men of West African Ancestry (Odedina et al) Nigeria per 100k Nigeria 61.3 Nigeria Jamaica 304 Jamaica 56.4 UK UK UK UK US 258.3

9 Genetics 9 % CaP due to inherited predisposition Family 1st degree relative 1, 2, 3 increased risk 2.5, 5, 11 fold Chromosomal linkage 1, 8, 10, 16, 17, 10 and X Chromosome 1 :HPC1 1q23-25, PCAP 1q42-43, CAPB 1p36 Polymorphisms Expression Trends in Disease Stage PSA Screening detects >75% CaP Decreased advanced and lymph node disease Walter Reed Decrease adv. dz 15-17%( ) to 4-6% ( ) DOD Center for Prostate Disease Research Surgery men <60 increased 24% to 41% Stage T1 increase 16% to 56.5% Stage T2 decreased 82% to 42% SEER between and distant disease AAM 27% to 12, White 18% to 7.5%, Hispanic 18% to 10%

10 References 1. Jemal A, Siegel R, Ward E et al. Cancer statistics, CA Cancer J Clin. 2009;59: Horner M, Ries L, et al SEER Cancer Statistics Review, Bethesda, MD: National Cancer Institute; Williams H, Powell IJ.(2009). Epidemiology, Pathology, and Genetics of Prostate Cancer Among African Americans Compared with Other Ethnicities. Methods of Molecular Biology, Cancer Epidemiology 472, Odedina F, et al (2009). Prostate Cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom and West Africa. Infectious Agents and Cancer 2009, 4(Suppl 1):S2, 1-8 References 5. Paquette EL et al Improved cancer-specific survival and other disease parameters: impact of prostate-specific antigen testing. Urology 60: , Moul JW et al: Epidemiology of radical prostatectomy for localized prostate cancer in the era of PSA. 132: , Smith CV et al. Prostate cancer in men age 50 years or younger. J Urol 164: , 2000