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Prostate cancer is the most common malignancy in men in the United States. In 2006 it is estimated that 234,460 new cases of prostate cancer will be diagnosed. In Iowa 2,700 men will be newly diagnosed with prostate cancer. Between 1988 and 1992, prostate cancer incidence rates increased dramatically, due to earlier diagnosis using the PSA blood test. Prostate cancer incidence rates subsequently declined and have leveled off, especially in the elderly. In ages under 65 years, however, rates have continued to increase, although at a less rapid rate. Prostate cancer incidence rates remain significantly higher in African American men than in white men.
An estimated 27,350 deaths will occur in the United States in 2006 due to prostate cancer. In Iowa approximately 410 men will die of prostate cancer. Although death rates have been declining among white and African American men since the early 1990s, rates in African American men remain more than twice as high as rates in white men.
The only well-established risk factors for prostate cancer are age, ethnicity, and family history of prostate cancer. More than 70% of all prostate cancer cases are diagnosed in men over age 65. African American men have the highest prostate cancer incidence rates in the world. Recent genetic studies suggest that strong familial predisposition may be responsible for 5 percent to 10 percent of prostate cancers. International studies suggest that dietary fat may also be a risk factor.
The prostate-specific antigen (PSA) blood test and the digital rectal examination should be offered annually beginning at age 50 to men who have a life expectancy of at least 10 years. Men at high risk (African Americans and men who have a first-degree relative diagnosed with prostate cancer at a young age) should begin testing at age 45.
There are several treatment options in the management of prostate cancer. The stage of cancer, grade of cancer, PSA level, age of patient, and other medical conditions of the patient should be taken into account when determining the best course of treatment. For localized prostate cancer, surgery or radiation therapy represent the mainstay of definitive treatment options. Recent studies have shown that hormone therapy along with radiation therapy may produce better outcomes than radiation therapy alone for some patients with high PSAs and/or bulky disease. Careful observation without immediate active treatment (“watchful waiting”) may be appropriate, particularly for older individuals with low-grade and/or early-stage tumors.
We reviewed all cases of prostate cancer diagnosed and/or treated at Mercy Medical Center in 2005. There were 99 cases for the year 2005. We have analyzed these cases in an attempt to learn more about our patient population, the treatment they received, and their outcome. Ninety-two percent of the men diagnosed with prostate cancer were over the age of 55 in 2005 as compared to ninety-four percent in 2003. Only 2 men were found to have prostate cancer under the age of 50. Fifty-three percent of the men diagnosed with prostate cancer were over the age of 65 in 2005 as compared to sixty-six percent in 2003.
In keeping with the national experience, most men diagnosed with prostate cancer at Mercy had disease confined to the prostate gland. Seventy percent were stage I or II (organ confined). Thirteen percent were stage III (regional spread). Four percent had stage IV disease (distant metastases) at the time of diagnosis.
In addition to the stage of prostate cancer, we also looked at the grade of cancer at the time of diagnosis. The Gleason system is accepted as the standard way of grading prostate cancer. It utilizes a numerical system where a higher number represents a more poorly differentiated cancer. The distribution of Gleason score is shown in graphic form. In keeping with the national experience, 81percent of our graded cases were in the middle group (Gleason Score of 5, 6, or 7).
As discussed above, localized prostate cancer can be treated with surgery, radiation therapy or “watchful waiting”. A combination of hormone therapy and radiation therapy has gained popularity in the treatment of prostate cancer due to the results of recent clinical trials showing superior outcome for some patients with adverse risk factors (high PSA and /or bulky disease). One hundred eighty-one patients were diagnosed with clinical stage I or II prostate cancer at Mercy Medical Center. Of those 181 patients, 24 percent were treated surgically. Seventy-six percent received radiation therapy. Of those patients receiving radiation therapy, approximately 50 percent also received hormone therapy.
In order to analyze the outcome of treatment and compare our outcomes with those of the U.S. as a whole, we analyzed the survival of Mercy Medical Center patients diagnosed with prostate cancer. The overall 5-year survival for all stages was 61.3 percent. This was the breakdown of cases by stage and survival rates: Stage 1-37.5 percent; Stage 2-71.6 percent; Stage 3-81.2 percent; Stage 4-17.6 percent and unknown stage-25 percent. In the U.S., according to NCDB data, the 5-year survival rate ranged from 76.91 percent for stage 1 to 35.75 percent for stage IV. The overall 5-year survival for all stages in the U.S. was 81.99 percent.
Mercy Medical Center continues to make strides to improve the care of prostate cancer patients. We have participated in a number of clinical trials, including the recently published Prostate Cancer Prevention Trial. We are currently accruing patients for the SELECT trial, a study evaluating the effect of selenium and vitamin E in the prevention of prostate cancer. We are also participating in several phase III trials that focus on the treatment of prostate cancer, including a number of studies that are evaluating intermittent androgen suppression. We are also in the process of developing a prostate brachytherapy program and will soon be initiating an IMRT program.
|Age At Diagnosis|
|0 to 19||2||2||3|
|20 to 29||19||18||18|
|30 to 39||58||49||58|
|40 to 49||167||182||169|
|50 to 59||257||295||337|
|60 to 69||350||347||418|
|70 to 79||404||374||388|
|80 to 89||185||210||205|