Trends in mortality rates in patients with prostate cancer during the era of prostate specific antigen screening

Purpose: We assess the influence of prostate specific antigen screening on trends in mortality rates in patients with prostate cancer. Materials and Methods: The incidence based mortality method was applied to prostate cancer data from the Surveillance, Epidemiology, and End Results Program. This method links data on patients diagnosed with cancer to vital status and cause of death, such that mortality can be evaluated by factors associated with disease at diagnosis. Prostate and nonprostate cancer mortality rates were evaluated according to patient age at death, disease stage and grade at diagnosis, race and whether additional cancers involving other sites were present. Results: Mortality due to prostate cancer decreased from 37% in 1988 to 30% in 1995 largely as a result of a sharp increase in nonprostate cancer mortality rates. The overall trend in prostate cancer mortality rates increased from 1988 through 1992 and then decreased. The increase and decrease in rates occurred across categories of age, race, grade and number of cancer primaries. However, the increase in rates did not occur in distant staged cases, nor did the subsequent decrease in rates occur in nondistant staged cases. Conclusions: Prostate specific antigen screening influenced the increase and decrease in prostate cancer mortality rates.