Secular trends in survival in prostate cancer (PC) (1992–2005) in a public hospital in Barcelona: Impact of PSA implementation and hormone-radiotherapy (HT+RT) treatment introduction—An observational study

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Background: There are reports of declines in mortality in several series and countries following introduction of PSA test. With routinely collected data we explore changes over time in PC survival, its correlation with PSA implementation and with the introduction of HT+RT. Methods: From the Hospital del Mar Cancer Registry we selected patients with histological confirmation of PC diagnosed between 1992 and 2005. Clinical and pathological stage, grade, PSA at diagnosis, type of treatment and follow-up until 2005 were available, and patients were grouped in three-years periods. Results: Out of 1,185 registered, 897 patients were evaluable. Median age at diagnosis decreased from 72 in 1992–96 to 70 in 2003–05 (p<.001). Median PSA at diagnosis decreased from 35 μg/ml to 14 μg/ml after 1996. Patients being diagnosed as metastatic changed from 67% before 1997 to 29% in 1997–99. A trend towards lower pathological stage has been observed, although in stage II and III no significant changes in risk group distribution were observed throughout the study period (χ2 =.318). Since 1999 there is a progressive increase in HT+RT indication in stages II and III with a significant decrease in the indication of surgery. There is an improvement in overall relative survival at 5 years before and after 1999, from 67,3% (CI: 60,2–75,2) to 92,9% (CI: 87,3–98,9).The same tendency was found in patients with localized tumour with intermediate and high risk coincidentally with the implementation of HT+RT. Conclusions: An increase in survival of patients with PC has been observed, coinciding with a shift towards lower stages and PSA levels at presentation, suggesting an influence of early detection by PSA. The increase in survival among localized tumors since 1999 could be explained by secular variations in the treatment of PC, as the implementation of HT+RT in patients with intermediate and high risk localized PC.

No significant financial relationships to disclose.