Amgen Inc., Thousand Oaks, California 91320, USA.
Urology. 2010 Jun;75(6):1396-404. doi: 10.1016/j.urology.2009.07.1360. Epub 2009 Dec 6.
To describe recent epidemiologic trends in stage IV prostate cancer. Although advances in screening and diagnostic techniques have led to earlier detection of prostate cancer, a portion of patients still present with late-stage disease.
Population-based cancer registry data from the Surveillance, Epidemiology, and End Results Program (cases from 1988 to 2003, follow-up through 2005) were used to calculate annual age-adjusted incidence rates of stage IV prostate cancer (overall and for the subset presenting with distant metastases) and to assess time trends in patient, tumor, and treatment characteristics and survival.
From 1988 to 2003, the age-adjusted incidence of stage IV prostate cancer significantly declined by 6.4% each year. The proportion of men diagnosed at younger ages, with poorly differentiated tumors, or who underwent a radical prostatectomy significantly increased over time. Five-year relative survival improved across the study period (from 41.6% to 62.3%), particularly in those diagnosed at younger ages or with moderately to well-differentiated tumors. Later years of diagnosis were independently associated with a decreased risk of death (from all causes and from prostate cancer specifically) after controlling for important patient, tumor, and treatment characteristics. Tumor grade and receipt of radical prostatectomy appeared to be the strongest independent prognostic indicators. Temporal trends were similar in the subset presenting with distant metastases, except that no significant improvement in survival was observed.
As younger men may expect to live longer with advanced prostate cancer, there remains a need to widen the range of therapeutic and supportive care options.
描述 IV 期前列腺癌的近期流行病学趋势。尽管筛查和诊断技术的进步导致前列腺癌的早期发现，但仍有一部分患者出现晚期疾病。
利用监测、流行病学和最终结果计划（1988 年至 2003 年的病例，随访至 2005 年）的基于人群的癌症登记数据，计算 IV 期前列腺癌（整体和远处转移亚组）的年度年龄调整发病率，并评估患者、肿瘤和治疗特征以及生存时间的趋势。
1988 年至 2003 年，IV 期前列腺癌的年龄调整发病率每年显著下降 6.4%。诊断时年龄较小、分化较差或接受根治性前列腺切除术的男性比例随时间推移而显著增加。整个研究期间，5 年相对生存率有所提高（从 41.6%提高至 62.3%），特别是在年龄较小或中至高分化肿瘤的患者中。在控制重要的患者、肿瘤和治疗特征后，较晚诊断与死亡风险（包括所有原因和前列腺癌特异性死亡）降低相关。肿瘤分级和接受根治性前列腺切除术似乎是最强的独立预后指标。在远处转移亚组中，趋势相似，但未观察到生存状况的显著改善。
由于年轻男性可能预期在患有晚期前列腺癌时能够活得更长，因此仍需要拓宽治疗和支持性护理方案的范围。
