CHICAGO — Advanced prostate cancer is being diagnosed increasingly in younger men aged 60 years or less in the United States, despite the widespread availability of prostate-specific antigen testing, according to epidemiologic evidence spanning 15 years from the Surveillance, Epidemiology, and End Results database.
“That's the bad news,” Dr. Michael Carducci said at the annual meeting of the American Society of Clinical Oncology, where he presented the data in a poster. “The good news is that they are living longer than ever before.”
Dr. Carducci, professor of medicine at Johns Hopkins University, Baltimore, tempered the good news with the observation that improved survival leaves these men vulnerable to serious physical and psychological side effects from increasingly successful treatments. Additionally, the natural history of advanced prostate cancer results in a protracted disease course, making reductions in quality of life a major concern, he said in an interview.
The retrospective cohort study, sponsored by Amgen Inc., found the age-adjusted incidence rate of stage IV prostate cancer was 28/100,000 men in 1988 and steadily declined to 12/100,000 men in 2003, for an average decrease of 6.4% per year (P less than .0001).
The proportion of stage IV prostate cancer patients diagnosed at younger ages increased over the course of the study, which was divided into two time periods—1988–1992 and 1998–2003. In the earlier time period, 1% of men 50 years or younger were diagnosed with stage IV prostate cancer; in the later time period, that proportion jumped to 4.1% (P less than .0001). Similarly, for men aged 51–60 years, that proportion went from 9% in 1988–1992 to 20% in 1998–2003 (P less than .0001).
Also noteworthy was the improvement in 5-year survival. From 1988 to 1999, this rate jumped from 43% to 61% among all stage IV patients, but the improvement was particularly dramatic in younger patients. Among men less than age 50 years, the 5-year survival went from 37% in 1988–1992 to 65% in 1998–1999, and in the 51- to 60-year-old age group, 5-year survival increased from 53% to 74%.
Dr. Carducci disclosed that he is a consultant to Amgen.