Impact of screening on prostate cancer rates and trends.

Widespread implementation of prostate cancer screening has affected several epidemiologic features of the disease including incidence, tumor and patient characteristics, patterns of care and outcomes. Some of these changes have been interpreted as evidence of the success of PSA testing as a cancer control strategy. Data are available from multiple sources to assess the association of early detection on recent prostate cancer rates and trends. National mortality data in the United States may be particularly informative because of the early and widespread adoption of PSA testing there. Incidence data from tumor registries and other regional resources are also relevant to this question. Case-control analyses and modeling of relevant rates and trends have recently been reported. Multiple sources of data show that prostate cancer incidence rates rose following the introduction of PSA testing. The average age at diagnosis has fallen, the proportion of advanced stage tumors has declined, the proportion of moderately differentiated tumors has increased, and patterns of care have changed accordingly. A decline in mortality began in the United States in 1991. The decline in mortality is well established but this recent trend may only retrace an increase in mortality that immediately preceded. The descriptive epidemiology of prostate cancer reveals many effects of the introduction of prostate cancer screening. Although the evidence suggests increased prostate cancer testing has yielded public health benefit, this has not yet been shown conclusively. Copyright 2000 Wiley-Liss, Inc.