Sharing the Decision Slide Set: Slide 21

Talking Points and Text Description of Slide

Slide 21 — What Happened to U.S. Prostate Cancer Mortality Rates as Screening Rates Increased?

Talking Points

What can we learn from trends in prostate cancer mortality? What happened to U.S. prostate cancer mortality rates as screening rates increased?

This is the same graph of mortality from prostate cancer that we showed earlier, but on a different scale so we can better see changes over time. Prostate cancer mortality in the United States increased modestly during the late 1970s and early 1980s, prior to the introduction of PSA testing.

Next, mortality rates increased between 1987 and 1990—when PSA screening was being adopted into usual practice. This increase is commonly said to be mainly attributable to changes in how cause of death was assigned on death certificates.

During the early 1990s, however, mortality rates began to stabilize and decline. Similar patterns of decline in prostate cancer mortality have occurred in other places where PSA screening has been introduced, for example in Olmsted County, Minnesota, and the Austrian state of Tyrol. The fact that prostate cancer mortality rates have declined in these populations as PSA testing increased suggests a positive benefit on mortality from screening.

Determining the causes of changes in U.S. prostate cancer mortality rates over time is difficult, however, because it is unclear exactly what changes in mortality might be expected and because there have been changes in treatments that may affect mortality. Because many prostate cancers grow slowly, a mortality decline from finding and treating early-stage cancers would have been expected to occur a few years later.

It is important to remember that new treatments were also introduced around the same time. For example, the use of hormonal treatments increased substantially, radical prostatectomy became more widely used, and other treatments were improved.

Sources: Albertsen, 2003; Ries et al., 2002; Hankey et al., 1999; Tarone et al., 2000; Feuer et al., 1999; Etzioni et al., 1999; Gann et al., 1995; Schmid et al., 1993; Brawley, 1997; Tovar-Guzman et al., 1999; Levi et al., 2000; Albertsen et al., 2000; Meyer et al., 1999; Oliver et al., 2000; Roberts et al., 1999; Bartsch et al., 2000; Bartsch et al., 2001; Potosky et al., 2001; Lu-Yao et al., 2002.

Text Description of Slide

Line graph shows trend of prostate cancer mortality rates per 100,000 from 1973 to 1999 as screening rates increased.