Characteristics and risk profile of this cohort of 123,934 patients are summarized in and stratified into four categories based on the pre-biopsy PSA value. Of these patients, 14% had a PSA value of ≤ 4 ng/ml, 73.5% had values between 4.1 and 20 ng/ml and 12.5% had values greater than 20 ng/ml. Compared to men in higher PSA groups, men with PSA values 4 ng/ml or less were younger and had lower Gleason scores. Of these patients with PSA values 4 ng/mL or less, 38% were screen detected. Approximately 54% of patients with PSA 4.0 ng/ml or less at diagnosis had low risk cancers compared to only 48% of men with PSA values between 4 and 10 (p<0.001). The percentage of patients who had intermediate or high risk cancer was positively associated with PSA level. Among patients who had PSA values greater than 20 ng/mL, 70% had tumor sizes larger than 0.5cm3, in contrast to 52%, 65% and 71% among patients who had PSA levels 0–4, 4.1–10 and 10.1–20 ng/ml respectively.
Clinical characteristics and primary therapy among prostate cancer patients by Prostate Specific Antigen Value, SEER (2004–2005)
Approximately 13% of the study cohort had PSA values greater than 20 ng/ml at diagnosis. These men were older and had higher tumor grades and stages of disease when compared to the remainder of the cohort. Their chance of having disease outside the prostate was 21% compared to only 1% for men with PSA values less than 4.0 ng/ml and 1.1% for men with PSA values between 4 and 20 ng/ml.
More than 70% of men with PSA values less than 20 ng/ml received either RP or RT. RP was performed on 44% of men with PSA values 4.0 ng/ml or less, 38% of men with PSA values 4.1–10 ng/ml and 24% of men with PSA values 10.1–20 ng/ml. Radiation was performed on 33% of men with PSA values 4.0 ng/ml or less, 40% of men with PSA values 4.1–10 ng/ml and 41.3% of men with PSA values 10–20 ng/ml.
presents the age standardized percentage distribution of treatments stratified by cancer stage, Gleason score and PSA level. Treatment patterns were similar across tumor stages with a slightly lower rate of intervention with either RT or RP in the group of men with T1 disease and a PSA value of 0 – 4 ng/ml (). Rates of attempted curative treatment were comparable among men with Gleason score 7 or 8–10 disease, but RP was slightly less common among men with Gleason 6 disease. Over half of the men with Gleason 2–5 disease received either RT or RP.
Age standardized percentage distribution of treatment according to tumor stage, cancer grade and prostate specific antigen (PSA) (A) PSA and tumor stage, (B) PSA and cancer grade, SEER 2004–2006.
The percentage of men who did not receive any attempted curative treatment was 27%, 22% and 36% respectively for men with low, intermediate and high risk disease. The results by age groupings are presented in . Conservative treatment strategies increased with patient age, especially for those men over age 75, while RP dominated among men age 65 years or less. RT was performed on approximately half of the men age 65–74, while RP was performed on approximately 1/3 of men with intermediate or high risk disease and much less frequently on men with low-risk disease.
Percentage distribution of therapy stratified by age, prostate specific antigen level and risk group, SEER 2004–2006
presents cancer features and uses of treatments among men with PSA value 4 ng/mL or less. Men with screen detected cancer were less likely to have high grade tumors (OR=0.67, CI=0.60–0.76), have disease outside the prostate (OR=0.30, CI=0.20–0.47) or have tumor size > 0.5 cm3 (OR=0.75, CI=0.68–0.83). However, these men were 1.49 times (CI 1.38–1.62) more likely to receive RP and 1.39 times (CI 1.30–1.49) to receive RT, compared to those with non–screen detected cancer.
High risk cancer features and use of radical prostatectomy or radiation by screen status among men with PSA value of 4 ug/mL or less.