Sharing the Decision Slide Set: Slide 7

Talking Points and Text Description of Slide

Slide 7 — Prostate Cancer Trends in Incidence and Mortality, 1973–1999

Talking Points

The risk of dying from or being diagnosed with prostate cancer has changed over time.

Let's look first at incidence—the rate of new cases—as shown by the top line. Note the general upward trend for detecting new prostate cancers—a substantial increase in the late 1980s, a peak around 1992, and a decline to a lower level.

The principal explanation for the dramatic increase in incidence in the late 1980s is that screening with PSA began to be adopted into usual practice. The steep rise was related to rapid and widespread dissemination of PSA test use for screening among men who had never been previously tested. A large pool of undetected prostate cancers was prevalent among those men. The peak was followed by a steep decline as the prevalent cancers in those men were detected.

Despite the decline from their peak, incidence rates in the mid and late 1990s remained higher than before the introduction of PSA testing. Continuing high rates could be due, in part, to the fact that some men had never had a PSA test and first-time PSA use among them was still finding prevalent cancers. Alternatively, the high rates may reflect, in part, the identification by PSA of cancers that otherwise would never have been detected. The latter issue, overdiagnosis of prostate cancer, is addressed later in the presentation.

As shown in the bottom line, mortality has changed but not as dramatically as incidence. We examine mortality rates in more detail later.

Sources: Ries et al., 2002; Etzioni et al., 2002; Potosky et al., 1995.

Text Description of Slide

Graph shows the trend of prostate cancer incidence and mortality rates from 1973 to 1990.