Prostate cancer Prevalence and survival in relation to PSA-testing Jan Adolfsson, MD, PhD Director Oncological Center Karolinska Institute Stockholm, Sweden
Radical prostatectomy Retropubic: antegrade retrograde Seminal vesicle Perineal Prostate
Localized prostate cancer
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 63000 alive with prostate cancer 39000 alive and diagnosed within 5 years
US Mail 1999
Prostate cancer incidence
Prostate cancer incidence
Cancer in Sweden 2006 National cancer registry, EpC, 2007
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 Njure1 10 9 8 7 6 1 844 427 365 352 284 238 210 139 138 124 Prostata Annan tumör i hud Urinorgan (exkl njure) Melanom i hud Tjocktarm Ändtarm, anus Testikel Non-Hodgkin lymfom Centrala nervsystemet Njure 10 9 8 7 6 5 4 3 2 1 12 469 2 854 2 825 2 642 2 328 1 411 1 378 1 150 1 128 908 0 10 20 30 40 0 10 20 30 40
Prostate cancer US Cancer Statistics Sweden 2006 300 250 Per 100 000 Figure F17: Prostate (icd-7:177) 200 150 100 50 0 1960 65 70 75 80 85 90 95 2000 05 Year of diagnosis Males Jemal, CA Cancer J Clin 2007 Cancerregistret, EpC, 2007
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
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. 2007 99:1881-1887; doi:10.1093/jnci/djm249 Copyright restrictions may apply.
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 http://astra.cancer.fi/cancer maps/nordic/ Kvale, R. et al. J. Natl. Cancer Inst. 2007 99:1881-1887; doi:10.1093/jnci/djm249 Copyright restrictions may apply.
Prostate cancer in Sweden NPCR 1996-2005 40 40 30 30 Percent 20 Percent 20 Ag- standardized rate per 100 000 men 10 0 80 70 60 50 40 30 20 10 0 0-49 50-59 60-69 70-79 80+ 0-49 50-59 60-69 70-79 80+ 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Ag- standardized rate per 100 000 men 10 0 80 70 60 50 40 30 20 10 0 T1a+T1bT1c T2 T3-T4 Other T1a+T1bT1c T2 T3-T4 Other 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Adolfsson et al, Scand J Urol Nephrol, 41:456, 2007
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 0,0 1987-1991 (47%) 1992-1996 (52%) 1997-2001 (61%) 2002-2006 (67%) 0 2 4 6 8 10 12 14 16 18 År Relativ överlevnad i cancer för män i Stockholm- Gotlandregionen. Uppdelning i fyra diagnosårsklasser. 5-års överlevnad inom parentes. Uppföljning till 2006-12-31. Kumulativ överlevnad 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 1987-1991 (65% ) 1992-1996 (70% ) 1997-2001 (82% ) 2002-2006 (90% ) 0 2 4 6 8 1 0 12 1 4 1 6 18 2 0 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 2 0 0 6-1 2-3 1. dx PSA dx clin death Regional Cancer Register, Stockholm/Gotland, 2007
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
Swedish population estimated 2003-2050 SCB, 2003
Estimated new cancer cases in Sweden up to 2030 Fi gur 2b. Ant al f al l av cancer f ör r i ket 45000 40000 35000 män kvi nnor Pop Pop+dis 30000 25000 20000 15000 10000 5000 0 1990 1995 2000 2005 2010 2015 2020 2025 2030 Den framtida ohälsan, Ahlbom, Adolfsson et al 2004
Estimated new cases of prostate caner in Sweden up to 2030 12000 10000 8000 6000 pc Linje 2 4000 2000 0 2003 2006 2009 2012 2015 2018 2021 2024 2027 2030 Den framtida ohälsan, Ahlbom, Adolfsson et al 2004
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
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
Dödsorsaksregistret, EpC, 2007
300 250 Per 100 000 Figure F17: Prostate (icd-7:177) Cancer i Sverige 2006 200 150 100 50 0 1960 65 70 75 80 85 90 95 2000 05 Year of diagnosis Males 160 Per 100 000 Figure F13: Breast (icd-7:170) 120 80 40 0 1960 65 70 75 80 85 90 95 2000 05 Year of diagnosis Females Cancerregistret, EpC, 2007
Relative survival in the NPCR 1996-2005 Relative survival 1 0.8 0.6 0.4 0.2 Metastatic disease ( n = 13362 ) Localised: PSA < 20, age < 75 ( n = 24133 ) All patients ( n = 72040 ) 0 0 1 2 3 4 5 6 7 8 Time (years) Adolfsson et al, Scand J Urol Nephrol, 41:456, 2007
http://astra.cancer.fi/cancermaps/nordic/