Temporal changes in survival in men with de novo metastatic prostate cancer: nationwide population-based study

Abstract

Background: There have been large changes in the pattern of detection, work-up and treatment of men with prostate cancer during the last two decades. Therefore, we aimed to investigate temporal changes in survival in men with metastatic prostate cancer. Methods: Population-based cohort study in Prostate Cancer data Base Sweden of 13,709 men with de novo metastatic prostate cancer diagnosed between 1998 and 2015. Overall survival in four calendar periods were compared by the use of Kaplan-Meier analyses and Cox regression models including age at diagnosis, T stage and serum levels of prostate-specific antigen (PSA). Results: Between 1998-2001 and 2010-2015, median survival increased with 6 months for all men. The largest increase in survival was 14 months in men age 60-69 at diagnosis and in multivariable analysis risk of death decreased for men diagnosed in 2010-2015 compared to 1998-2001, hazard ratio (HR) 0.77 (95% CI: 0.68-0.86). The median PSA at date of diagnosis decreased with 46% from 181 ng/mL in 1998 to 98 ng/mL in 2015. Conclusions: There was an increase in survival among men with de novo metastatic prostate cancer in Sweden between 1998 and 2015. This increase was due to a decreased cancer extent indicated by lower PSA levels with ensuing longer lead times and speculatively also due to an increased use of chemotherapy in the latest time period. Given the increasing use of systemic treatment for advanced prostate cancer, our results are likely heralding larger increases in survival in men with metastatic prostate cancer in the near future.

Prediction of metastatic prostate cancer by prostate-specific antigen in combination with T stage and Gleason Grade: Nationwide, population-based register study

“…Moreover, the specificity for PSA 100 ng/mL was low, so a large number of men without metastatic disease would be misclassified if this PSA level was used to define presence of bone metastasis. The most likely explanation for the difference in predictive value between the studies from the nineties and the more current studies is a stage migration caused by increased use of PSA testing [21,24].…”

“…We aimed to impute the clinical stages 'metastatic prostate cancer' and 'non-metastatic prostate cancer', corresponding to the results of a bone imaging under the hypothetical scenario in which all men had undergone such an investigation. The imputation procedure has previously been applied and described and the number of multiple imputations was set to 20 with 10 iterations [21].…”

Time spent in hormone-sensitive and castration-resistant disease states in men with advanced prostate cancer, and its health economic impact: registry-based study in Sweden

“…Most men who are diagnosed with prostate cancer have localized disease, some of whom subsequently start androgen deprivation therapy (ADT) due to cancer progression. Approximately 15% of men with prostate cancer have metastasis at diagnosis, and these men have short survival [3]. Since the 1940s, ADT had been the mainstay treatment for metastatic (m) prostate cancer [4].…”

Survival and mortality of elderly men with localized prostate cancer managed with primary androgen deprivation therapy or by primary observation

“…This implies that staging procedures of PCa by bone scans were widely performed even in the earlier years of the study period, suggesting a good quality of the TNM classification data of PCa in the Finnish Cancer Registry database. In the Finnish Cancer Registry reports, the proportion of de novo metastatic PCa has recently been around 17%, higher than in Sweden [32], where the incidence of PCa is high and PSA screening is widely performed. This might also indicate a more aggressive PCa histology in cases that are classified as localized by the TNM system, and thus more commonly treated with immediate ADT than cases with less aggressive histology.…”