The National Cancer Data Base report on prostate carcinoma after the peak in incidence rates in the U. S.

BACKGROUND: Prostate carcinoma incidence has been declining since 1992 after a period of marked increase. Recent data from the National Cancer Data Base (NCDB) were examined to assess changes in prostate carcinoma patient characteristics and disease and treatment patterns coincidental to this decline. The NCDB is a program of the American College of Surgeons Commission on Cancer and the American Cancer Society that collects timely data from institutions representing every level of cancer care. METHODS: Data from 1114 hospitals regarding 103,979 patients diagnosed with prostate carcinoma in 1992 and from 1144 hospitals regarding 72,337 patients diagnosed in 1995 were studied. Patient and disease characteristics studied included age, race, American Joint Committee on Cancer stage, and tumor histologic grade. Trends in treatment and variations in treatment by region also were examined. RESULTS: The average age at diagnosis declined by 2 years over the period studied and the proportion of patients identified as African-American increased from 8.8% to 11.8%. The proportion of patients diagnosed with localized disease and the proportion of tumors of moderately differentiated histologic grade increased. The overall proportion of patients treated by radical prostatectomy increased and the use of external beam radiation treatment decreased. Substantial regional variation in treatment patterns was observed. The Pacific and Mountain state regions of the U. S. had the highest proportions of patients treated by radical prostatectomy although increases were occurring in other regions. Use of external beam radiation treatment was highest in the Northeast and Southeast states and was declining in the majority of regions. Use of brachytherapy radiation treatment by implantation of radioactive seeds was infrequent but increasing. CONCLUSIONS: Comparison of the basic characteristics of prostate carcinoma data from 1992 and 1995 shows that patients are being diagnosed at younger ages and earlier stages, the proportion of African-Americans has increased, and more patients are being treated for cure. Regional differences in patterns of care persist but may be moderating. The annual prostate carcinoma death rate in the U.S. has declined an average of 1% per year since 1990.