A population-based study of progression to metastatic prostate cancer in Australia. Issue 4 (August 2015)

• Record Type: Journal Article
• Authors: Luo, Qingwei; Yu, Xue Qin; Smith, David Paul; O'Connell, Dianne Lesley
• Is Part Of: Cancer epidemiology. Volume 39:Issue 4(2015)
• Page Start: 617
• Page End: 622
• Publication Date: 2015-08
• Subjects: NSW New South Wales -- CCR Central Cancer Registry -- SES socio-economic status -- ASR age-standardised incidence rate -- LGA local government area -- ASGC Australian Standard Geographic Classification -- IRSD Index of Relative Socio-economic Disadvantage -- PSA prostate-specific antigen -- HR hazard ratio -- CI confidence interval; Disease progression -- Prostate cancer -- Stage at diagnosis -- Distant metastases -- Geographical location -- Socio-economic status -- Population-based study -- Cancer registry -- Geographical disparity; Cancer -- Epidemiology -- Periodicals; Cancer -- Prevention -- Periodicals; Cancer -- Diagnosis -- Periodicals; Carcinogenesis -- Periodicals; 616.994005
• DOI: 10.1016/j.canep.2015.04.013
• Languages: English
• ISSNs: 1877-7821

Abstract

Highlights: The first population-based study to examine the patterns of metastatic prostate cancer disease progression. Overall, 20.6% of non-metastatic prostate cancer cases developed distant metastases after a median follow-up of 6.8 years. The trends in the cumulative incidence of metastatic prostate cancer continuously increased up to 14 years of follow-up. The study confirmed that distant metastatic prostate cancer can develop over the long term. These results should help to inform the development of cancer services where they are most required. Abstract: Background: We used population-based data from the New South Wales Central Cancer Registry (CCR) to describe the patterns of progression to metastatic disease in Australian men diagnosed with non-metastatic prostate cancer. Methods: Data for all non-metastatic prostate cancer cases diagnosed 1993–2002 and followed to the end of 2007 were analysed. The outcome was progression to metastatic disease, identified by metastatic episode notifications in the CCR or by prostate cancer death. Factors associated with metastatic disease progression were identified using Cox regression models. Results: Of the 32, 643 men with non-metastatic prostate cancer at diagnosis 43.1% had localised disease, 5.1% had regional spread and 51.9% had unknown stage. After a median of 6.8 years of follow-up 6708 cases (20.6%) had developed distant metastases. The risk of developing metastatic disease was significantly higher for those with regional (adjusted HR = 2.65, 95% CI: 2.40–2.93) or unknown initial stage (adjusted HR = 1.70, 95% CI: 1.61–1.80), for older men (65–74 years: HR = 1.43, 95% CI: 1.33–1.53; >74 years: HR = 2.73, 95% CI: 2.55–2.93), and those living in inner regional (HR = 1.11, 95% CI: 1.04–1.18) or rural areas (HR = 1.24, 95% CI: 1.14–1.36) or more disadvantaged areas (middle tertile: HR = 1.09, 95% CI: 1.02–1.16; most disadvantaged: HR = 1.12, 95% CI: 1.04–1.19). The risk of developing metastatic disease decreased over calendar time (adjusted HR = 0.98, 95% CI: 0.97–0.99 per year). Conclusions: After a median follow-up of 6.8 years more than 1 in 5 men diagnosed with non-metastatic prostate cancer developed distant metastases. This estimate of the overall risk of developing metastatic disease in the population, and the geographical disparities identified, can inform the planning of required cancer services.