Reduced incidence of bony metastasis at initial prostate cancer diagnosis: Data from CaPSURE™

Ryan, Charles J.; Elkin, Eric P.; Small, Eric J.; Duchane, Janeen; Carroll, Peter

doi:10.1016/j.urolonc.2005.09.003

« Previous Next »Urologic Oncology: Seminars and Original Investigations
Volume 24, Issue 5 , Pages 396-402, September 2006

Reduced incidence of bony metastasis at initial prostate cancer diagnosis: Data from CaPSURE™☆

Charles J. Ryan, M.D.
- Department of Medicine, and UCSF Comprehensive Cancer Center, University of California–San Francisco, San Francisco, CA 94143, USA
- Corresponding author. Tel.: +1-415-353-9279; fax: +1-415-353-7779.
Eric P. Elkin, M.P.H.
- Department of Urology, and UCSF Comprehensive Cancer Center, University of California–San Francisco, San Francisco, CA 94143, USA
Eric J. Small, M.D.
- Department of Medicine, and UCSF Comprehensive Cancer Center, University of California–San Francisco, San Francisco, CA 94143, USA
Janeen Duchane, Ph.D.
- TAP Pharmaceutical Products, Inc., Lake Forest, IL 60045, USA
Peter Carroll, M.D.
- Department of Urology, and UCSF Comprehensive Cancer Center, University of California–San Francisco, San Francisco, CA 94143, USA

Received 12 July 2005; received in revised form 1 September 2005; accepted 2 September 2005.

Abstract

Purpose

Despite stage migration as a result of screening, many individuals are diagnosed each year with metastatic (M+), as opposed to localized (M0), prostate cancer. This study describes features that characterize patients with M+ compared to those diagnosed with M0 disease.

Materials and Methods

Patients enrolled in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE™), a national, longitudinal registry of men with prostate cancer, formed the basis of this study. The prevalence, and changes with time, of patients with M+ and M0 cancer by clinical and sociodemographic characteristics were examined.

Results

Of 10,113 patients diagnosed between 1990 and 2003, 266 (2.6%) had M+ disease at diagnosis. From 1990 to 1997, 4.2% of 4020 total patients had M+ versus 1.6% of 6093 total patients diagnosed between 1998 and 2003 (odds ratio 0.34; 95% confidence interval 0.24−0.48; P < 0.0001). In univariate analysis, advanced age, higher prostate-specific antigen, Gleason grade, black race, lower income, and lower educational level were associated with M+ versus M0 disease (P < 0.01). However, in multivariate analysis, only higher serum prostate-specific antigen and higher Gleason grade, and not the sociodemographic variables, remained associated with M+ disease (P < 0.01). Patients with M+ diagnosed between 1998 and 2003 are more likely to harbor high-grade (Gleason ≥8) primary tumors (62% vs. 45%, P = 0.02) than those diagnosed between 1990 and1997. No changes in age, race, education, insurance status, or income were observed in the early versus late era.

Conclusions

These findings show a reduction in the incidence of metastatic disease at initial prostate cancer diagnosis. Furthermore, biologic, rather than socioeconomic, factors are associated with this type of disease presentation.

Keywords: Prostate cancer epidemiology , Prostate-specific antigen screening , Bone metastasis

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☆ CaPSURE™ is supported by TAP Pharmaceutical Products, Inc. (Lake Forest, IL). This research was additionally funded by the National Institutes of Health/National Cancer Institute University of California–San Francisco, SPORE—Special Program of Research Excellence p50c89520.