10 Renal & Urology News FEBRUARY 2010 www.renalandurologynews.com
Metastatic Prostate Cancer Worse
Declined from 1988 to 2003 Outcomes
LYMPHOVASCULAR invasion (LVI)
The age-adjusted incidence dropped by an average of 6.4% a year independently predicts both recur-
rence-free survival and cancer-speciﬁc
METASTATIC prostate cancer con- and 12.5%, respectively, for men diag- Furthermore, the study showed that survival in patients undergoing radical
tinues to decline in incidence, but the nosed during 1998-2003. older age (71 years or older), black race, nephroureterectomy (RNU) for urothe-
proportion of cases being diagnosed in During the study period, ﬁve-year higher tumor grade, and lack of radical lial carcinoma of the upper urinary
younger men is increasing, according relative survival increased from 41.6% prostatectomy generally conferred a tract, researchers concluded.
to a study. to 62.3%. Men diagnosed at youn- poorer prognosis, “most likely reﬂect- At nine centers in European, Asia,
Researchers analyzed population- ger ages or with moderately to well- ing differences between subgroups of and Canada, investigators studied 762
based cancer registry data from 24,251 differentiated tumors had particularly patients with respect to biological fac- patients treated with RNU for upper
cases of stage IV prostate cancer dramatic improvements in survival. tors related to survival, access to care, tract urothelial carcinoma (UTUC)
diagnosed from 1988 to 2003. They For men aged 35-50 years, rela - nature and extent of comorbiditiy, and without neoadjuvant chemotherapy
obtained data from the Surveillance, tive five-year survival rose from response to available treatments.” and without pathologic slide review.
Epidemiology, and End Results (SEER) 33.0% in 1988-1992 to 64.8% in The proportion of stage IV tumors that The researchers, led by Shahrokh
Program. Overall, the age-adjusted 1998-2001; for men aged 51-60 years, were poorly differentiated at diagnosis F. Shariat, MD, of Memorial Sloan-
rose signiﬁcantly from 42.7% during the Kettering Cancer Center in New York,
period 1988 to 1992 to 48.8% during found LVI in 148 patients (19.4%). At
Stage IV Prostate Cancer Decreasing 1998 to 2003, and the percentage of a median follow-up of 34 months, dis-
The overall age-adjusted incidence, in cases per 100,000 population, of stage IV prostate those of lower grades decreased. ease recurred in 23.5% of subjects and
cancer and the incidence of patients with distant metastases at diagnosis decreased from 19.8% died from UTUC. The ﬁve-year
1988 to 2003, a study showed. Treatment trends recurrence-free survival and cancer-
The proportion of men who received speciﬁc survival rates were 79.3% and
30% radiation as part of ﬁrst-line therapy 82.1%, respectively, in the absence of
Overall incidence increased slightly during the study LIV compared with 45.1% and 45.8%,
Incidence of distant metastases at diagnosis period, primarily among men with respectively, in the presence of LVI, Dr.
20% distant metastases, but more than 75% Shariat’s group reported in European
15% 18.4% of patients did not receive any form Urology (2010; published online ahead
of radiation, the authors reported. of print).
10% 12.3% In addition, the researchers, led LVI was associated with a 3.3 times