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

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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.

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Acknowledgement

This research was funded by grants from the Agency for Health Care Research and Quality (HS 08397, HS 10278).

Conflict of Interest Statement

None disclosed.

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Authors and Affiliations

  1. The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Grace Lu-Yao PhD

  2. Division of Urology, The University of Connecticut Health Center, Farmington, CT, USA

    Peter C. Albertsen MD

  3. Division of Public Health Sciences, Programs in Epidemiology and Prostate Cancer, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Janet L. Stanford PhD

  4. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Therese A. Stukel PhD

  5. Medical Practices Evaluation Center, Massachusetts General Hospital, Boston, MA, USA

    Elizabeth Walker-Corkery MPH & Michael J. Barry MD

Authors
  1. Grace Lu-Yao PhD
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  2. Peter C. Albertsen MD
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  3. Janet L. Stanford PhD
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  4. Therese A. Stukel PhD
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  5. Elizabeth Walker-Corkery MPH
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  6. Michael J. Barry MD
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Corresponding author

Correspondence to Michael J. Barry MD.

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Lu-Yao, G., Albertsen, P.C., Stanford, J.L. et al. Screening, Treatment, and Prostate Cancer Mortality in the Seattle Area and Connecticut: Fifteen-year Follow-up. J GEN INTERN MED 23, 1809–1814 (2008). https://doi.org/10.1007/s11606-008-0785-8

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  • DOI: https://doi.org/10.1007/s11606-008-0785-8

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