Age and PC

www.ncbi.nlm.nih.gov/pubmed/26646364

"CONCLUSIONS:
Guidelines discouraging routine prostate cancer screening were temporally associated with declining localized/regional prostate cancer incidence rates; however, incidence rates of distant-stage disease are now increasing in younger men.

IMPACT:
This trend may adversely affect prostate cancer mortality rates. Cancer Epidemiol Biomarkers Prev; 25(2); 1-5. ©2015 AACR."

My thoughts exactly Beth

NewDay said...
With Active Surveillance a standard protocol in treatment. Doctor's sponsorship and patient education of the treatment option. I would think, the guidelines of annual PSA testing starting in your mid 40's would be the message of choice.

I realize that the term cancer causes people to react strongly with aggressive treatment. We need Doctors to be that person in the room, to explain "'why" AS is a very valid treatment for PCa. In addition, the medical community as a whole, should be producing information to support Doctors efforts on AS.

We need not to deny those, who truly have a silent killer in the house, the alert (PSA) of the intruder in the hallway.

Agree 100%. The NCCN just recently announced support for AS even for G3+4 (7) PCa, under certain criteria:

www.medscape.com/viewarticle/857151

JackH, I agree with the First, Second, Third and Fourth screening scenario. I think the Fifth is related to biopsies. I would rather we go to a targeted biopsy solution after a couple of PSAs that are rising (maybe adding PSA free to the mix to track also). Obviously because of my personal experience, I am biased against the elevated PSA straight to random biopsy scenario. Just my 2 cents as a early 50s high risk PC guy.

Thanks NewDay. Anxious at this point.

Alas, the original poster's observation is indeed a self fulfilling prophesy...

halbert said...
Left at least partially untested (thanks Pratoman for the citation) is whether high-risk cancer is increasing in younger men. It appears that it is. Or, has it also always been there and we're just finding it more often? Unproven, and likely unproveable.

Appearances may be deceptive. A well-worn theme for high school literature class, originally ascribed to Aesop. But as John Ruskin said, “The work of science is to substitute facts for appearances.”

The facts you seek are neither “untested,” “unproven,” nor “unprovable.” They are measured.

They are measured and reported in the SEER seer.cancer.gov/ database, the Surveillance, Epidemiology and End Results program of the National Cancer Institute. The most recently available data analysis was published in 2012.

The relevant SEER data shows three things. FIRST, as I previously mentioned, an increasing rate of incidence (newly diagnosed) amongst men in the 40-49 age group. I previously reported in this thread that less than 10% of all new cases were age 55 and under. In fact, SEER reports that less than 3% are under age 50. Recent trends show that this age category is the fastest growing age category, increasing at 3%/year. Notably, annual percentage change the incidence rate 50-59 age group is flat (unchanged) and all older age groups have a negative rate of change. But this is all just another way of saying, as JohnT did, “It's because they are being screened earlier and more frequently.”

But your question is a SECOND piece of SEER data, “whether high-risk cancer is increasing in younger men?” The answer to this question is “no.” The SEER data for men in the 40-49 age group shows that the annual percentage change (APC) in the rate localized PC is virtually indistinguishable from the APC of regional PC at 3.4% and 3.5% respectively. These are statistically insignificant differences; in fact, the 95% CI for the localized APC is completely within the range of the 95% CI for the regional CI…naturally, the CI for the regional APC is wider because of such a higher incidence of localized PC. APC of PC staged as distant for ages 40-49 is significantly lower at 1.5%.

So with that knowledge, the better THIRD question to ask is “is there a notable difference in frequency of each stage of diagnosis for men 40-49 compared to the larger population of all men.” To this, the answer is “yes.” Compared to all men, the 40-49 age group is less frequently diagnosed with localized PC by about 3 percentage points, and is diagnosed with regional disease 5 percentage point more frequently. Here’s a table:
..........................ALL MEN.......AGE 40-49
Localized...............81.6%.......... 78.4%
Regional................10.0%...........15.0%
Distant...................3.1%............2.9%
Unstaged................5.3%............3.6%


So, the theory you anecdotally thought you “observed” and subsequently went on a fishing expedition for is not valid…BUT, there is interesting relevant data. In summary, younger men are being diagnosed at increasing rates although there doesn’t not appear to be an increasing rate of “high-risk” cases amongst younger men, BUT younger men to tend to be diagnosed with slightly worse stages than the broader population.

Post Edited (JackH) : 2/10/2016 9:28:54 AM (GMT-7)

Is the 40-49 age group being diagnosed more often? -- yes, the FIRST point in my earlier posting
Is there a greater change of them having aggressive cancer? -- no, the SECOND point in my earlier posting


I think the point you are struggling to make may be this: There are more men 40-49 who have been diagnosed with PC...as a statistician would say, the count is higher.

This is true and this is directly a result of doctors "looking harder" for PC in this age category. But the breakdown between localized and regional stages, based on recent trends for this age group, does not appear to be changing at different rates. The implied hypothesis was that there was an increased percentage of newly diagnosed cases 40-49 which were higher-risk...that's simply not true.




The most recent SEER data is 2012. Don't even think of implying that there's been a significant shift in the descriptive statistics since then...

glad to help

I understand trolling on a political forum, but I cannot imagine any one trolling on such an important forum as this one! I'm still trying to get my son to get tested (age 45 years). This truly worries me!

halbert said...
The good scientist is always willing to be proven wrong.

Agreed. Quite a number of times I've added a note to my posts that I'd go back and change something I posted if I was later shown to be "wrong" because I wouldn't want incorrect information out there. (Actually, I think I said that earlier in this thread, too.)


halbert, I hope you did get the point point relevant to the original question which seemed to pass right over alphanull (I think jpenn got it). There likely ARE more 40-49s showing up here because although small they are the fastest growing segment. (It's just that their rate of high-grade PC is not growing faster than their rate of low-grade PC.)

Let's just say that the whole screening/not screening controversy is far from settled, and the question remains that if you're not going to screen those who are at risk--particularly the under 50 crowd--what is the alternative? I understand the difference been mass screening and educated focused screening, but we also have to deal with the effects of mass media and blaring headlines. Most people don't read 5000 word articles in Atlantic or New Yorker to understand the nuances---and most PCP's, with their 15 minute exam schedules don't have time to do more than throw a pamphlet or two at an at risk patient.

I do agree that the answer is education, not just of patients, but of physicians, nurses, PA's, public health officials, and on and on. If we do the education side correctly, then we'll solve the overtreatment problem AND catch the 43 year old before they show up at 50 with distant mets and a shortened lifespan.