Incidence of Prostate Cancer

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Fred Schwartz - 09 Mar 2007 13:38 GMT

Does anyone have a good recent reference for the following: 1)
incidence of PC by age; 2) incidence of PC by age as found at routine
autopsy. I ask about the second because I understand that occult PC
is more common than anticipated when one does a routine autopsy.

Thanks,
Fred

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ron - 09 Mar 2007 16:19 GMT

> Does anyone have a good recent reference for the following: 1)
> incidence of PC by age; 2) incidence of PC by age as found at routine
[quoted text clipped - 3 lines]
> Thanks,
> Fred

Fred...A good place to get statistics on PCa, or any other cancer, is
the SEER database. Incidence rates by age can be found at
http://seer.cancer.gov/csr/1975_2002/results_merged/sect_23_prostate.pdf

As to incidence upon incidence stratified by age, I am not aware of
anything recent. Sakr's paper (In Vivo. 1994 May-Jun;8(3):439-43;
High grade prostatic intraepithelial neoplasia (HGPIN) and prostatic
adenocarcinoma between the ages of 20-69: an autopsy study of 249
cases; Sakr WA, Grignon DJ, Crissman JD, Heilbrun LK, Cassin BJ,
Pontes JJ, Haas GP.) is the one usually cited to support the rule of
thumb that PCa incidence increases by 10% for every decade of life
(e.g. 50% at age 50, 70% at age 70, etc.). Slide 15 at
http://www.medscape.com/viewarticle/537156_19
tells a similar story, but it too is based upon a 1996 paper by Sakr.

You say, "occult PC is more common than anticipated when one does a
routine autopsy"; if I understand you, I think you mean that with all
of the testing going on today, particularly in the US, many men are
being unnecessarily treated today. This is true, many men being
treated today would have died with, but not from, PCa, had they not
undergone treatment. Estimates of the percentage of men who are
unnecessarily treated range from 20-60%. Years ago, prior to PSA
testing, more men died from PCa and fewer were overtreated. Today,
the pendulum has shifted, fewer men die from PCa, but more are
overtreated. Hopefully, as screening protocols and test methodologies
improve, we will move to a more satisfactory middle ground. As a
result of this overtreatment, rates of PCa found upon autopsy in men
over 40 have declined from 4.8% during 1955-60 to 1.2% between
1991-2001...Best wishes and good health, ron

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Leonard Evens - 14 Mar 2007 17:06 GMT

>> Does anyone have a good recent reference for the following: 1)
>> incidence of PC by age; 2) incidence of PC by age as found at routine
[quoted text clipped - 33 lines]
> over 40 have declined from 4.8% during 1955-60 to 1.2% between
> 1991-2001...Best wishes and good health, ron

It should be added that there is a big difference between evidence of
prostate cancer on autopsy and clinically detected prostate cancer.

Studies have shown that that many older men will show evidence of
prostate cancer on autopsy. Unfortunately, if you do a google search,
you will see a large variation in the numbers. For men in the 80s for
example, some studies seem to show that almost all such men will show
such evidence. The figures ron quoted above, which you can find with
google, come from what seems an solid study, but the figures are much
lower than what others state. Clearly, there must be some difference in
how the terms are being defined. So it is possible you may not find a
clear definitive answer to your question. I've tried myself on several
occasions without success. I've decided just to accept what Peter
Scardino says on the subject in his book. He says that studies have
shown that one third of men over 50 will show such tumors on autopsy
and that the percentage rises to as high as 80 percent in men in their 80s.

On the other hand note that the likelihood of being diagnosed with
prostate cancer sometime in life remains has been consistently roughly
15 percent. Take what ron says very seriously. Certainly, many men
being treated for prostate cancer today would never have been bothered
by it during their lifetimes. Some of those men suffer significant side
effects of the treatment. Unfortunately, we have no foolproof way to
distinguish those cases which need to be treated from those which don't,
and of course the consequences of leaving prostate cancer untreated can
be very serious.

For any man who has been diagnosed with prostate cancer, the issue is
how to balance the risks of treatment against the risks of developing
metastatic uncontrolled prostate cancer. That can depend on the details
of the diagnosis and the man's age and expected lifetime. For
example, a relatively young man with a T1C, Gleason 6, PSA less than 10
cancer has a good chance of avoiding serious side effects from
treatment, and if untreated, his cancer has more time to get out of
control. A man in his 70s with the same diagnosis might opt for less
aggressive treatment or even for watchful waiting.

In my own case, my diagnosis was T1C, Gleason 7=3+4, PSA 4.5 diagnosed
at age 67. I was in relatively good health and could be expected to
live at least another 15 years. The Gleason 7 suggested that without
treatment there was a significant risk of metastasis within 10 years.
Few experts would not recommend aggressive treatment in such a case. So
the silver lining to my particular cloud was that I have few doubts
that I made the right decision. The results of my post-surgical
pathology suggest that my chances of a recurrence are very small, and
I've been able to deal with side effects so my life is not disrupted.

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