TY - JOUR
T1 - Prostate cancer changes in clinical presentation and treatments in two decades
T2 - an Italian population-based study
AU - Trama, Annalisa
AU - Botta, Laura
AU - Nicolai, Nicola
AU - Rossi, Paolo Giorgi
AU - Contiero, Paolo
AU - Fusco, Mario
AU - Lodde, Michele
AU - Pannozzo, Fabio
AU - Piffer, Silvano
AU - Puppo, Antonella
AU - Seeber, Andreas
AU - Tumino, Rosario
AU - Valdagni, Riccardo
AU - Gatta, Gemma
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Introduction The incidence of prostate cancer is on the rise in many industrialised countries, including Italy, most likely because of the spread of PSA testing. In Italy, prostate cancer mortality has been dropping since 2000, but it is difficult to understand whether PSA testing is the main reason, considering the role of treatment in prognosis. The objectives of this study were: (1) to describe Italian trends of prostate cancer risk categories and corresponding changes in treatment patterns and (2) to interpret changes in survival over time. Methods We made a retrospective observational study using population-based cancer registries. We examined two periods, 1996–1999 and 2005–2007, analysing the distribution of patients among risk groups and treatment changes in those intervals. We estimated 7- and 15-year relative survival with the cohort approach, Ederer II method. We analysed 4635 cases. Results There was downward risk migration from the first to the second period. In patients younger than 75 years, there was an increase in radical prostatectomy but not radiotherapy; patients older than 75 years rarely had treatment with radical intent. We noted an improvement of prostate cancer survival in the high-risk group. Conclusion These findings raise several questions: the possible overtreatment of low-risk patients undergoing radical treatment; the utility of more aggressive treatment for elderly patients with high-risk disease; and the importance of a multidisciplinary clinical approach to ensure multiple and alternative treatment options. The increase in survival, with the decrease in mortality, suggests an effect of radical treatments on prognosis.
AB - Introduction The incidence of prostate cancer is on the rise in many industrialised countries, including Italy, most likely because of the spread of PSA testing. In Italy, prostate cancer mortality has been dropping since 2000, but it is difficult to understand whether PSA testing is the main reason, considering the role of treatment in prognosis. The objectives of this study were: (1) to describe Italian trends of prostate cancer risk categories and corresponding changes in treatment patterns and (2) to interpret changes in survival over time. Methods We made a retrospective observational study using population-based cancer registries. We examined two periods, 1996–1999 and 2005–2007, analysing the distribution of patients among risk groups and treatment changes in those intervals. We estimated 7- and 15-year relative survival with the cohort approach, Ederer II method. We analysed 4635 cases. Results There was downward risk migration from the first to the second period. In patients younger than 75 years, there was an increase in radical prostatectomy but not radiotherapy; patients older than 75 years rarely had treatment with radical intent. We noted an improvement of prostate cancer survival in the high-risk group. Conclusion These findings raise several questions: the possible overtreatment of low-risk patients undergoing radical treatment; the utility of more aggressive treatment for elderly patients with high-risk disease; and the importance of a multidisciplinary clinical approach to ensure multiple and alternative treatment options. The increase in survival, with the decrease in mortality, suggests an effect of radical treatments on prognosis.
KW - Clinical presentation
KW - Population-based cancer registries
KW - Prostate cancer
KW - Survival
KW - Treatments
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U2 - 10.1016/j.ejca.2016.07.021
DO - 10.1016/j.ejca.2016.07.021
M3 - Article
AN - SCOPUS:84986268742
VL - 67
SP - 91
EP - 98
JO - European Journal of Cancer
JF - European Journal of Cancer
SN - 0959-8049
ER -