The National Survey of Prostate Cancer in the United States by the American College of Surgeons

Abstract

Data from the 1980 long-term and short-term surveys of the American College of Surgeons Commission on Cancer were examined to identify recent trends in the management of prostate cancer. The clinical stage distribution of patients demonstrates that higher proportions of patients were diagnosed as having occult or incidental and advanced stage D disease in the 1979 study as opposed to the 1974 series. In both periods black patients were diagnosed less often as having localized stage cancer and were observed more often to have advanced diseases. Transurethral resection and rectal examination were reported as the most common means of diagnosing prostate cancer. In both series alkaline and serum acid phosphatase studies were performed on the majority of patients, although the use was greater in the 1979 series. The use of bone scans increased nearly 3-fold from 1974 to 1979. In the long-term survey (1974 and earlier) hormone therapy was the treatment used most often, either alone or in combination with surgery or radiation. This treatment was used in many patients with metastatic disease. In the short-term survey (1979 and earlier) a larger proportion of patients with each stage of disease underwent transurethral resection only and a smaller proportion was observed to receive hormonal therapy. The use of radiation therapy appeared to have increased, particularly for stages B and C disease in the 1979 series. At 5 yr from initial diagnosis, 77.7% of patients with clinical stage A disease survived compared to 23% with clinical stage D cancer. Throughout the study black patients had a poorer survival rate than white patients. During the study interval (1974-1979) the disease was staged clinically and graded histologically by various systems in most patients. The near complete results described in 1980 suggest an excellent geographic application of these important factors in patient management. Overall, these results suggest changing patterns of care for prostatic cancer in the patients observed from 1974 to 1979.