Prostate carcinoma practice patterns

Because of the high disease burden attributable to prostate carcinoma, the availability of the prostate specific antigen (PSA) assay as a detection test as well as a variety of intervention options in early prostate carcinoma detection and treatment would appear to be a common sense strategy for reducing disease specific morbidity and mortality. However, convincing evidence of a benefit from this strategy is lacking. Adequately designed randomized trials to assess the efficacy of early prostate carcinoma detection and treatment have not been completed. Therefore, cancer registries and population-based cohorts have been utilized to examine variations in disease incidence rates, practice patterns, and outcomes in an attempt to determine the preferred strategies for prostate carcinoma care. The article by Sandblom et al. in this issue of Cancer describes temporal trends in prostate carcinoma incidence and treatment in the southeast region of Sweden between 1987–1996. Their report provides a comparison with data from registries in the U.S. and other countries. Sandblom et al. and others note that although the incidence rate of prostate carcinoma is lower in Sweden then the U.S., mortality is higher. The rise and fall in carcinoma incidence and advanced stage disease in the U.S. has been used as evidence that early diagnosis and aggressive therapy will improve outcome. Although encouraging, such simple comparisons are unreliable indicators of whether early detection and treatment improve the length and quality of life. The authors point out differences in factors known to alter mortality including age, histologic grade, coexisting medical conditions, and coding of deaths. Men from Sweden were older and less likely to have clinically localized, and more likely to have poorly differentiated, prostate carcinoma then men in the U.S. Practice patterns and health outcomes from population data between countries and across regions within the U.S. provide further evidence that early detection and treatment may not increase the length and quality of life. In contrast to cervical carcinoma screening, declines in prostate carcinoma mortality are small in magnitude and do not demonstrate geographic, temporal, or practice specific consistencies. Similar to the U.S., the age-adjusted incidence rate of and mor1277