Heikki A Seikkula1,2, Antti J Kaipia3, Matti E Rantanen4, Janne M Pitkäniemi4, Nea K Malila4,5, Peter J Boström2. 1. a Department of Surgery , Central Hospital of Central Ostrobothnia , Kokkola , Finland. 2. b Department of Urology , Turku University Hospital, University of Turku , Turku , Finland. 3. c Satakunta Hospital District , Pori , Finland. 4. d Finnish Cancer Registry , Helsinki , Finland. 5. e School of Health Sciences , University of Tampere, Tampere , Finland.
Abstract
BACKGROUND: The early diagnosis and right treatment strategy of localized prostate cancer (PCa) remains problematic. In order to characterize the survival of PCa patients, we compared patients' all-cause and cancer-specific mortalities between pre- and post-PSA periods by stage in Finland. MATERIAL AND METHODS: All PCa cases diagnosed in Finland between 1985 and 2013 (N = 91,329) were identified from the Finnish Cancer Registry (FCR). PCa stage at diagnosis was defined as localized, local node positive or metastasized. Standardized mortality ratios (SMRs), and relative and cause-specific survival were assessed by stage and introduction of PSA testing. The main limitation was the high proportion of men with unknown stage (28%). RESULTS: A clear decreasing trend in the SMR of PCa patients was evident when pre- and post-PSA eras were compared: for localized PCa, the SMR was 1.43 (95%CI 1.38-1.48) in 1985-1989 and 0.98 (95%CI 0.95-1.01) in 2000-2004, and for metastasized PCa, the SMRs were 4.51 (95%CI 4.30-4.72) and 3.01 (95%CI 2.89-3.12), respectively. Difference between cause-specific and relative survival was pronounced in localized PCa in post-PSA period: 10-year relative survival was 94.6% (95%CI 91.4-97.8) and cause-specific 84.2% (95%CI 82.9-85.5%). In metastasized PCa the difference was not that significant. CONCLUSIONS: From 1985 to 2009, the SMR among men diagnosed with PCa decreased significantly in Finland. Among men with localized PCa, the SMR decreased even below that of the Finnish male population. This and the increased difference between relative and cause-specific survival reflects most likely selection of men to opportunistic PSA testing. The results highlight the importance of caution in the use of PSA testing in healthy men.
BACKGROUND: The early diagnosis and right treatment strategy of localized prostate cancer (PCa) remains problematic. In order to characterize the survival of PCa patients, we compared patients' all-cause and cancer-specific mortalities between pre- and post-PSA periods by stage in Finland. MATERIAL AND METHODS: All PCa cases diagnosed in Finland between 1985 and 2013 (N = 91,329) were identified from the Finnish Cancer Registry (FCR). PCa stage at diagnosis was defined as localized, local node positive or metastasized. Standardized mortality ratios (SMRs), and relative and cause-specific survival were assessed by stage and introduction of PSA testing. The main limitation was the high proportion of men with unknown stage (28%). RESULTS: A clear decreasing trend in the SMR of PCa patients was evident when pre- and post-PSA eras were compared: for localized PCa, the SMR was 1.43 (95%CI 1.38-1.48) in 1985-1989 and 0.98 (95%CI 0.95-1.01) in 2000-2004, and for metastasized PCa, the SMRs were 4.51 (95%CI 4.30-4.72) and 3.01 (95%CI 2.89-3.12), respectively. Difference between cause-specific and relative survival was pronounced in localized PCa in post-PSA period: 10-year relative survival was 94.6% (95%CI 91.4-97.8) and cause-specific 84.2% (95%CI 82.9-85.5%). In metastasized PCa the difference was not that significant. CONCLUSIONS: From 1985 to 2009, the SMR among men diagnosed with PCa decreased significantly in Finland. Among men with localized PCa, the SMR decreased even below that of the Finnish male population. This and the increased difference between relative and cause-specific survival reflects most likely selection of men to opportunistic PSA testing. The results highlight the importance of caution in the use of PSA testing in healthy men.
Authors: Anssi Auvinen; Antti Rannikko; Kimmo Taari; Paula Kujala; Tuomas Mirtti; Anu Kenttämies; Irina Rinta-Kiikka; Terho Lehtimäki; Niku Oksala; Kim Pettersson; Teuvo L Tammela Journal: Eur J Epidemiol Date: 2017-07-31 Impact factor: 8.082
Authors: Otto Ettala; Ivan Jambor; Ileana Montoya Perez; Marjo Seppänen; Antti Kaipia; Heikki Seikkula; Kari T Syvänen; Pekka Taimen; Janne Verho; Aida Steiner; Jani Saunavaara; Ekaterina Saukko; Eliisa Löyttyniemi; Daniel D Sjoberg; Andrew Vickers; Hannu Aronen; Peter Boström Journal: BMJ Open Date: 2022-04-15 Impact factor: 3.006