National Cancer Institute 171 SEER Survival Monograph INTRODUCTION This study … This study provides survival analyses for 275,280 histologically confirmed adult cases of prostate cancer diagnosed from 1988 through 2001. Cases were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (NCI). The SEER Program — a sequel to two earlier NCI initiatives, the End Results Program and the Third National Cancer Survey — has evolved in response to the National Cancer Act of 1971, which requires the collection, analysis, and dissemination of data relevant to the prevention, diagnosis, and treatment of cancer. This study analyzes the influence of clinical extent of disease, histologic grade, age at diagnosis, race/ethnicity, SEER registry, and type of therapy on prostate cancer survival.
the analyses used 1988-2001 data. For 1988-2001, the EOD data were converted to a more simplistic staging system of localized (confined to the prostate); regional (extension beyond the prostate by direct extension and/ or involvement of regional nodes), and distant disease (metastasis). A comparison of the three sets of EOD codes and stage is shown in Table 22.1. Relative Survival The survival analysis is based on relative survival rates calculated by the life-table method. The relative rate is used to estimate the effect of cancer on the survival of the cohort. Relative survival, defined as observed survival divided by expected survival, adjusts for the expected mortality that the cohort would experience from other causes of death. When the 5-year relative survival is 100%, for example, a patient has the same chance to live 5 more years as a cancer-free person of the same race, age and sex. Exclusions The following cases were excluded from the analysis (as shown in Table 22.2): patients for whom prostate cancer was not the first primary, cases identified through autopsy or death certificate only, persons of unknown race, cases without active follow-up, patients less than 20 years old, in situ cases, cases without microscopic confirmation, and sarcomas. After the exclusions, there were 275,280 prostate cases for analysis. RESULTS Characteristics of Cases During the 14-year period (1988-2001) during which these cases were diagnosed, 42% were aged 65-74 at diagnosis compared to 29% 20-64 and 29% aged 75 or over (Table 22.3). Blacks had a higher proportion of cases in the youngest age group compared to whites. Eighty-eight percent of all cases were diagnosed with localized disease, 3% had regional disease, 4% had distant disease, and another 4% had unknown stage of disease. Blacks had a higher proportion with distant disease and unknown stage than did whites (Table 22.4). The majority of all cases (60%), had tumors that were graded as moderately differentiated (Gleason Score 5-7) (Table 22.3). Relative Survival by Stage of Disease Stage of disease at diagnosis is a critical determinant of relative survival among prostate cancer cases. Among all cases, there is 100% relative survival rate at 1, 2, 3, 4, and 5 years after diagnosis (Table 22.4). Blacks fared slightly worse than whites after 3 years from diagnosis. The distribution of cases by stage at diagnosis, will affect the overall group’s relative survival rate and blacks had a higher proportion of distant disease cases than whites (Table 22.3), which may contribute to their slightly lower survival. For localized disease, white males and black males had 100% survival through the first 5-years after diagnosis. A 100% relative survival rate does not mean that no men will die from prostate cancer but rather that they do not have excess mortality compared to comparably aged men of the same race. For regional disease, there is a 6 percentage point difference between whites (90%) and blacks (84%) at 5 years. Among those with distant disease, both groups did poorly, approximately 35% survived 5-years (Table 22.4). Figure 22.1 shows the continuous relative survival curve by stage of disease by race over the years after diagnosis….
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