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Dickinson J, Shane A, Tonelli M, Connor Gorber S, Joffres M, Singh H, Bell N. Trends in prostate cancer incidence and mortality in Canada during the era of prostate-specific antigen screening. CMAJ Open 2016; 4:E73-9. [PMID: 27280117 PMCID: PMC4866930 DOI: 10.9778/cmajo.20140079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Widespread use of prostate-specific antigen (PSA) to screen for prostate cancer began in the early 1990s. Advocates for screening assert that this has caused a decrease in prostate cancer mortality. We sought to describe secular changes in prostate cancer incidence and mortality in Canada in relation to the onset of PSA screening. METHODS Age-standardized and age-specific prostate cancer incidence (1969-2007) and mortality (1969-2009) from Public Health Agency of Canada databases were analyzed by joinpoint regression. Changes in incidence and mortality were related to introduction of PSA screening. RESULTS Prior to PSA screening, prostate cancer incidence increased from 54.2 to 99.8 per 100 000 between 1969 and 1990. Thereafter, incidence increased sharply (12.8% per year) to peak at 140.8/100 000 in 1993. After decreasing in all age groups between 1993 and 1996, incidence continued to increase for men aged less than 70 years, but decreased for older men. Age-standardized mortality was stable from 1969 to 1977, increased 1.4% per year to peak in 1995 and subsequently decreased at 3.3% per year; the decline started from 1987 in younger men (age < 60 yr). INTERPRETATION Incidence was increasing before PSA screening occurred, but rose further after it was introduced. Reductions in prostate cancer mortality began before PSA screening was widely used and were larger than could be anticipated from screening alone. These findings suggest that screening caused artifactual increase in incidence, but no more than a part of reductions in prostate cancer mortality. The reduction may be due to changing treatment or certification of death.
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Affiliation(s)
- James Dickinson
- University of Calgary Medical Centre, Family Medicine; University of Calgary, Community Health Sciences (Dickinson), Calgary, Alta.; Public Health Agency of Canada (Shane) Ottawa, Ont.; University of Calgary, Cumming School of Medicine; University of Calgary, Office of the Vice President (Research) (Tonelli), Calgary, Alta.; Public Health Agency of Canada, Preventive Health Care Division (Connor Gorber), Ottawa, Ont.; Simon Fraser University (Joffres), Faculty of Health Sciences, Vancouver, BC; Department of Internal Medicine (Singh), University of Manitoba, Winnipeg, Man.; Family Medicine/Public Health Sciences (Bell), University of Alberta, Edmonton, Alta
| | - Amanda Shane
- University of Calgary Medical Centre, Family Medicine; University of Calgary, Community Health Sciences (Dickinson), Calgary, Alta.; Public Health Agency of Canada (Shane) Ottawa, Ont.; University of Calgary, Cumming School of Medicine; University of Calgary, Office of the Vice President (Research) (Tonelli), Calgary, Alta.; Public Health Agency of Canada, Preventive Health Care Division (Connor Gorber), Ottawa, Ont.; Simon Fraser University (Joffres), Faculty of Health Sciences, Vancouver, BC; Department of Internal Medicine (Singh), University of Manitoba, Winnipeg, Man.; Family Medicine/Public Health Sciences (Bell), University of Alberta, Edmonton, Alta
| | - Marcello Tonelli
- University of Calgary Medical Centre, Family Medicine; University of Calgary, Community Health Sciences (Dickinson), Calgary, Alta.; Public Health Agency of Canada (Shane) Ottawa, Ont.; University of Calgary, Cumming School of Medicine; University of Calgary, Office of the Vice President (Research) (Tonelli), Calgary, Alta.; Public Health Agency of Canada, Preventive Health Care Division (Connor Gorber), Ottawa, Ont.; Simon Fraser University (Joffres), Faculty of Health Sciences, Vancouver, BC; Department of Internal Medicine (Singh), University of Manitoba, Winnipeg, Man.; Family Medicine/Public Health Sciences (Bell), University of Alberta, Edmonton, Alta
| | - Sarah Connor Gorber
- University of Calgary Medical Centre, Family Medicine; University of Calgary, Community Health Sciences (Dickinson), Calgary, Alta.; Public Health Agency of Canada (Shane) Ottawa, Ont.; University of Calgary, Cumming School of Medicine; University of Calgary, Office of the Vice President (Research) (Tonelli), Calgary, Alta.; Public Health Agency of Canada, Preventive Health Care Division (Connor Gorber), Ottawa, Ont.; Simon Fraser University (Joffres), Faculty of Health Sciences, Vancouver, BC; Department of Internal Medicine (Singh), University of Manitoba, Winnipeg, Man.; Family Medicine/Public Health Sciences (Bell), University of Alberta, Edmonton, Alta
| | - Michel Joffres
- University of Calgary Medical Centre, Family Medicine; University of Calgary, Community Health Sciences (Dickinson), Calgary, Alta.; Public Health Agency of Canada (Shane) Ottawa, Ont.; University of Calgary, Cumming School of Medicine; University of Calgary, Office of the Vice President (Research) (Tonelli), Calgary, Alta.; Public Health Agency of Canada, Preventive Health Care Division (Connor Gorber), Ottawa, Ont.; Simon Fraser University (Joffres), Faculty of Health Sciences, Vancouver, BC; Department of Internal Medicine (Singh), University of Manitoba, Winnipeg, Man.; Family Medicine/Public Health Sciences (Bell), University of Alberta, Edmonton, Alta
| | - Harminder Singh
- University of Calgary Medical Centre, Family Medicine; University of Calgary, Community Health Sciences (Dickinson), Calgary, Alta.; Public Health Agency of Canada (Shane) Ottawa, Ont.; University of Calgary, Cumming School of Medicine; University of Calgary, Office of the Vice President (Research) (Tonelli), Calgary, Alta.; Public Health Agency of Canada, Preventive Health Care Division (Connor Gorber), Ottawa, Ont.; Simon Fraser University (Joffres), Faculty of Health Sciences, Vancouver, BC; Department of Internal Medicine (Singh), University of Manitoba, Winnipeg, Man.; Family Medicine/Public Health Sciences (Bell), University of Alberta, Edmonton, Alta
| | - Neil Bell
- University of Calgary Medical Centre, Family Medicine; University of Calgary, Community Health Sciences (Dickinson), Calgary, Alta.; Public Health Agency of Canada (Shane) Ottawa, Ont.; University of Calgary, Cumming School of Medicine; University of Calgary, Office of the Vice President (Research) (Tonelli), Calgary, Alta.; Public Health Agency of Canada, Preventive Health Care Division (Connor Gorber), Ottawa, Ont.; Simon Fraser University (Joffres), Faculty of Health Sciences, Vancouver, BC; Department of Internal Medicine (Singh), University of Manitoba, Winnipeg, Man.; Family Medicine/Public Health Sciences (Bell), University of Alberta, Edmonton, Alta
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Almeida M, Costa VL, Costa NR, Ramalho-Carvalho J, Baptista T, Ribeiro FR, Paulo P, Teixeira MR, Oliveira J, Lothe RA, Lind GE, Henrique R, Jerónimo C. Epigenetic regulation of EFEMP1 in prostate cancer: biological relevance and clinical potential. J Cell Mol Med 2014; 18:2287-97. [PMID: 25211630 PMCID: PMC4224561 DOI: 10.1111/jcmm.12394] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/18/2014] [Indexed: 12/20/2022] Open
Abstract
Epigenetic alterations are common in prostate cancer (PCa) and seem to contribute decisively to its initiation and progression. Moreover, aberrant promoter methylation is a promising biomarker for non-invasive screening. Herein, we sought to characterize EFEMP1 as biomarker for PCa, unveiling its biological relevance in prostate carcinogenesis. Microarray analyses of treated PCa cell lines and primary tissues enabled the selection of differentially methylated genes, among which EFEMP1 was further validated by MSP and bisulfite sequencing. Assessment of biomarker performance was accomplished by qMSP. Expression analysis of EFEMP1 and characterization of histone marks were performed in tissue samples and cancer cell lines to determine the impact of epigenetic mechanisms on EFEMP1 transcriptional regulation. Phenotypic assays, using transfected cell lines, permitted the evaluation of EFEMP1’s role in PCa development. EFEMP1 methylation assay discriminated PCa from normal prostate tissue (NPT; P < 0.001, Kruskall–Wallis test) and renal and bladder cancers (96% sensitivity and 98% specificity). EFEMP1 transcription levels inversely correlated with promoter methylation and histone deacetylation, suggesting that both epigenetic mechanisms are involved in gene regulation. Phenotypic assays showed that EFEMP1 de novo expression reduces malignant phenotype of PCa cells. EFEMP1 promoter methylation is prevalent in PCa and accurately discriminates PCa from non-cancerous prostate tissues and other urological neoplasms. This epigenetic alteration occurs early in prostate carcinogenesis and, in association with histone deacetylation, progressively leads to gene down-regulation, fostering cell proliferation, invasion and evasion of apoptosis.
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Affiliation(s)
- Mafalda Almeida
- Cancer Biology and Epigenetics Group, Research Center of the Portuguese Oncology Institute - Porto, Porto, Portugal
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Tuppin P, Samson S, Fagot-Campagna A, Lukacs B, Alla F, Paccaud F, Thalabard JC, Vicaut E, Vidaud M, Millat B. Prostate cancer outcomes in France: treatments, adverse effects and two-year mortality. BMC Urol 2014; 14:48. [PMID: 24927850 PMCID: PMC4067687 DOI: 10.1186/1471-2490-14-48] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 06/10/2014] [Indexed: 11/25/2022] Open
Abstract
Background This very large population-based study investigated outcomes after a diagnosis of prostate cancer (PCa) in terms of mortality rates, treatments and adverse effects. Methods Among the 11 million men aged 40 years and over covered by the general national health insurance scheme, those with newly managed PCa in 2009 were followed for two years based on data from the national health insurance information system (SNIIRAM). Patients were identified using hospitalisation diagnoses and specific refunds related to PCa and PCa treatments. Adverse effects of PCa treatments were identified by using hospital diagnoses, specific procedures and drug refunds. Results The age-standardised two-year all-cause mortality rate among the 43,460 men included in the study was 8.4%, twice that of all men aged 40 years and over. Among the 36,734 two-year survivors, 38% had undergone prostatectomy, 36% had been treated by hormone therapy, 29% by radiotherapy, 3% by brachytherapy and 20% were not treated. The frequency of treatment-related adverse effects varied according to age and type of treatment. Among men between 50 and 69 years of age treated by prostatectomy alone, 61% were treated for erectile dysfunction and 24% were treated for urinary disorders. The frequency of treatment for these disorders decreased during the second year compared to the first year (erectile dysfunction: 41% vs 53%, urinary disorders: 9% vs 20%). The frequencies of these treatments among men treated by external beam radiotherapy alone were 7% and 14%, respectively. Among men between 50 and 69 years with treated PCa, 46% received treatments for erectile dysfunction and 22% for urinary disorders. For controls without PCa but treated surgically for benign prostatic hyperplasia, these frequencies were 1.5% and 6.0%, respectively. Conclusions We report high survival rates two years after a diagnosis of PCa, but a high frequency of PCa treatment-related adverse effects. These frequencies remain underestimated, as they are based on treatments for erectile dysfunction and urinary disorders and do not reflect all functional outcomes. These results should help urologists and general practitioners to inform their patients about outcomes at the time of screening and diagnosis, and especially about potential treatment-related adverse effects.
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Affiliation(s)
- Philippe Tuppin
- National general health insurance scheme (Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, CNAMTS), Paris, France.
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