Journal List > Korean J Urol > v.50(5) > 1005326

Kwon, Chang, Kim, and Myung: Changes in Prostate Cancer Pattern according to Prostate-Specific Antigen Screening Test

Abstract

Purpose

The aim of this study was to investigate the changes in the clinical and prognostic parameters of prostate cancer in Korean men in the eras before and after prostate-specific antigen (PSA) testing.

Materials and Methods

The medical records of 303 patients treated for prostate cancer between 1982 and 2005 were reviewed with respect to age, chief complaints, clinical stage, tumor grade, treatment options, and prognosis. We classified the patients as follows: those treated in the pre-PSA era (1982-1995, n=81), and those treated in the PSA era (1996-2000, PSA era phase 1, n=92; and 2001-2005, PSA era phase 2, n=130).

Results

There was no significant difference in age or clinical stage between patients treated before and those treated during the PSA era, although there was a downward migration of grade. The cancer-specific survival rates were also not different in all cases and in metastatic prostate cancer cases between the pre-PSA era and the PSA era, although the overall survival rates were significantly greater in all cases in phase 2 of the PSA era than in the pre-PSA era or in phase 1 of the PSA era (p<0.05). However, the cancer-specific survival rates for localized or locally advanced prostate cancer were significantly greater in phase 2 of the PSA era than in the pre-PSA era or in phase 1 of the PSA era (p<0.05).

Conclusions

We observed a downward migration of tumor grade, but there were no migrations in the age of patients or clinical stage, and these findings have not contributed to changes in the cancer survival of Korean men with prostate cancer after the advent of PSA testing.

Figures and Tables

Fig. 1
Kaplan-Meier survival curves of prostate cancer in the pre and post prostate-specific antigen (PSA) eras. (A) Overall survival curves of all cases. (B) Cancer-specific survival curves of all cases. (C) Cancer-specific survival curves of localized or locally advanced prostate cancer. (D) Cancer-specific survival curves of metastatic prostate cancer.
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Table 1
Demographics of patients with prostate cancer in the pre and post PSA eras
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PSA: prostate-specific antigen, SD: standard deviation

Table 2
Comparison of treatment options in the pre and post PSA eras
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PSA: prostate-specific antigen, LHRH: luteinizing hormone-releasing hormone, T: total patient (n=202), L: localized or locally advanced prostate cancer patients (n=143), M: metastatic prostatic cancer patients (n=160), Statistical significance: a: p<0.01, b: p<0.05

Table 3
Cause of death (n=164)
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Table 4
Cancer-specific survival rate according to clinical stage (%)
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PSA: prostate-specific antigen

Notes

This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A085138).

References

1. Shin HR, Won YJ, Jung KW, Kong HJ, Yim SH, Lee JK, et al. Nationwide cancer incidence in Korea, 1999-2001: first result using the national cancer incidence database. Cancer Res Treat. 2005. 37:325–331.
2. Korean National Statistical Office. The cause of death statistics, 1983-2003. 2005. Seoul: Korean National Statistical Office.
3. Sim HG, Cheng CW. Changing demography of prostate cancer in Asia. Eur J Cancer. 2005. 41:834–845.
4. Park SK, Sakoda LC, Kang D, Chokkalingam AP, Lee E, Shin HR, et al. Rising prostate cancer rates in South Korea. Prostate. 2006. 66:1285–1291.
5. Jung KW, Yim SH, Kong HJ, Hwang SY, Won YJ, Lee JK, et al. Cancer survival in Korea 1993-2002: a population-based study. J Korean Med Sci. 2007. 22:Suppl. S5–S10.
6. Newcomer LM, Stanford JL, Blumenstein BA, Brawer MK. Temporal trends in rates of prostate cancer: declining incidence of advanced stage disease, 1974 to 1994. J Urol. 1997. 158:1427–1430.
7. Okihara K, Kitamura K, Okada K, Mikami K, Ukimura O, Miki T. Ten year trend in prostate cancer screening with high prostate-specific antigen exposure rate in Japan. Int J Urol. 2008. 15:156–160.
8. Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E, et al. Cancer statistics, 2004. CA Cancer J Clin. 2004. 54:8–29.
9. Stephenson RA, Smart CR, Mineau GP, James BC, Janerich DT, Dibble RL. The fall in incidence of prostate carcinoma. On the down side of a prostate specific antigen induced peak in incidence--data from the Utah Cancer Registry. Cancer. 1996. 77:1342–1348.
10. Hankey BF, Feuer EJ, Clegg LX, Hayes RB, Legler JM, Prorok PC, et al. Cancer surveillance series: interpreting trends in prostate cancer--part I: evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates. J Natl Cancer Inst. 1999. 91:1017–1024.
11. Derweesh IH, Kupelian PA, Zippe C, Levin HS, Brainard J, Magi-Galluzzi C, et al. Continuing trends in pathological stage migration in radical prostatectomy specimens. Urol Oncol. 2004. 22:300–306.
12. American Cancer Society. Cancer facts and figures 2005. 2005. Atlanta: American Cancer Society.
13. Sirovich BE, Schwartz LM, Woloshin S. Screening men for prostate and colorectal cancer in the United States: Does practice reflect the evidence? JAMA. 2003. 289:1414–1420.
14. Okihara K, Nakanishi H, Nakamura T, Mizutani Y, Kawauchi A, Miki T. Clinical characteristics of prostate cancer in Japanese men in the eras before and after serum prostate-specific antigen testing. Int J Urol. 2005. 12:662–667.
15. Simone NL, Singh AK, Cowan JE, Soule BP, Carroll PR, Litwin MS. Pretreatment predictors of death from other causes in men with prostate cancer. J Urol. 2008. 180:2447–2451.
16. Desireddi NV, Roehl KA, Loeb S, Yu X, Griffin CR, Kundu SK, et al. Improved stage and grade-specific progression-free survival rates after radical prostatectomy in the PSA era. Urology. 2007. 70:950–955.
17. Park HK, Hong SK, Byun SS, Lee SE. Comparison of the rate of detecting prostate cancer and the pathologic characteristics of the patients with a serum PSA level in the range of 3.0 to 4.0 ng/ml and the patients with a serum PSA level in the range 4.1 to 10.0 ng/ml. Korean J Urol. 2006. 47:358–361.
18. Sohn DW, Byun SS, Lee SE. Predictive factors and characteristics of the prostate cancer in patients with serum PSA levels equal or less than 4.0 ng/ml. Korean J Urol. 2005. 46:565–568.
19. Lee SW, Byun SS, Lee SE. The diagnostic significance of abnormal findings on transrectal ultrasonography in patients with serum prostate-specific antigen levels equal or less than 4.0 ng/ml. Korean J Urol. 2006. 47:752–756.
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