Original Article

Journal of General Internal Medicine

, Volume 23, Issue 11, pp 1809-1814

First online:

Screening, Treatment, and Prostate Cancer Mortality in the Seattle Area and Connecticut: Fifteen-year Follow-up

  • Grace Lu-YaoAffiliated withThe Cancer Institute of New Jersey, Robert Wood Johnson Medical School
  • , Peter C. AlbertsenAffiliated withDivision of Urology, The University of Connecticut Health Center
  • , Janet L. StanfordAffiliated withDivision of Public Health Sciences, Programs in Epidemiology and Prostate Cancer, Fred Hutchinson Cancer Research Center
  • , Therese A. StukelAffiliated withInstitute for Clinical Evaluative Sciences
  • , Elizabeth Walker-CorkeryAffiliated withMedical Practices Evaluation Center, Massachusetts General Hospital
  • , Michael J. BarryAffiliated withMedical Practices Evaluation Center, Massachusetts General Hospital Email author 

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Abstract

Background

Prior to introduction of the prostate-specific antigen (PSA) test, the Seattle–Puget Sound and Connecticut Surveillance, Epidemiology and End Results (SEER) areas had similar prostate cancer mortality rates. Early in the PSA era (1987–1990), men in the Seattle area were screened and treated more intensively for prostate cancer than men in Connecticut.

Objective

We previously reported more intensive screening and treatment early in the PSA era did not lower prostate cancer mortality through 11 years and now extend follow-up to 15 years.

Design

Natural experiment comparing two fixed population-based cohorts.

Subjects

Male Medicare beneficiaries ages 65–79 from the Seattle (N = 94,900) and Connecticut (N = 120,621) SEER areas, followed from 1987–2001.

Measurements

Rates of prostate cancer screening; treatment with radical prostatectomy, external beam radiotherapy, and androgen deprivation therapy; and prostate cancer-specific mortality.

Main Results

The 15-year cumulative incidences of radical prostatectomy and radiotherapy through 2001 were 2.84% and 6.02%, respectively, for Seattle cohort members, compared to 0.56% and 5.07% for Connecticut cohort members (odds ratio 5.20, 95% confidence interval 3.22 to 8.42 for surgery and odds ratio 1.24, 95% confidence interval 0.98 to 1.58 for radiation). The cumulative incidence of androgen deprivation therapy from 1991–2001 was 4.78% for Seattle compared to 6.13% for Connecticut (odds ratio 0.77, 95% confidence interval 0.67 to 0.87). The adjusted rate ratio of prostate cancer mortality through 2001 was 1.02 (95% C.I. 0.96 to 1.09) in Seattle versus Connecticut.

Conclusion

Among men aged 65 or older, more intensive prostate cancer screening early in the PSA era and more intensive treatment particularly with radical prostatectomy over 15 years of follow-up were not associated with lower prostate cancer-specific mortality.

Key Words

prostate cancer cancer screening men’s health outcomes practice variation