Exploring Causes For Declining Prostate Cancer Mortality Rates In The United States

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology;  Men's health
Article Date: 15 Jan 2009 - 3:00 PDT

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UroToday.com - A question that has never been clearly answered is, following the introduction of PSA screening in the US in 1989, why prostate cancer (CaP) deaths increased between 1989 and 1993, then decreased from 1993 to 2003. The initial increase was felt to have been caused by misattribution bias - in other words many more living men with a diagnosis of CaP, and some fixed proportion of those men who died of other causes, were misattributed to death from CaP. In the Nov-Dec issue of Urologic Oncology, Drs. Janet Colli and Christopher Amling compared declining CaP mortality rates with levels of PSA screening, health insurance coverage, obesity, physical inactivity, diabetes, and high cholesterol.

The investigators studied men over age 50 included from 1979 to 2003 in the National Vital Statistic System database at the National Center for Health Statistics of the Centers for Disease Control and Prevention. Death rates were calculated by the National Cancer Institute and age-adjusted to the 2000 US standard population by 5-year age groups.

Declining CaP mortality rates for white males correlated with high cholesterol levels and PSA screening levels. No other independent variable for white males correlated with declining CaP mortality rates. Other cross-correlations included diabetes with physical inactivity, obesity and high cholesterol. Obesity correlated strongly to physical inactivity. Among black males, declining CaP mortality rates correlated with health insurance coverage. There was also a correlation between PSA screening levels and diabetes levels, but no other variables cross-correlated.

The authors point out that while cholesterol is considered a risk factor for CaP, the extensive use of statins in this population is associated with a decreased risk of CaP. This relationship has been especially suggested between statin use and advanced and fatal CaP. Health insurance coverage and access to health care was not a factor in white men, but appeared to be so in black men.

Colli JL, Amling CL
Urol Oncol. 2008 Nov-Dec;26(6):627-33
doi:10.1016/j.urolonc.2007.05.016

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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