Prostate specific antigen (PSA) testing has had a significant impact on the statistics that describe the natural history of prostate cancer. The decline in incidence and mortality from advanced prostate cancer, in particular, suggest that PSA may be a factor contributing to the recently observed fall in prostate cancer deaths. Population-based data are complex, however, and the relatively modest declines in prostate cancer mortality may be the result of multiple causes. Further followup is needed to ensure that the observed declines are sustainable, note Brian Kessler, M.D., and Peter Albertsen, M.D., of the University of Connecticut Health Center. Their work was supported in part by the Agency for Healthcare Research and Quality (HS09578).
Drs. Kessler and Albertsen reviewed key research that has contributed to the understanding of the natural history of prostate cancer and long-term outcomes in the pre-PSA and PSA eras. For instance, since the introduction of PSA testing during the late 1980s, the incidence of prostate cancer has risen dramatically, and mortality from the disease has declined. In 1991, prostate cancer caused 26.7 deaths per 100,000 men at risk, which declined to 24.9 per 100,000 by 1995, a decrease of 6.7 percent. Declining prostate cancer mortality is supported by the significant declines in the incidence of advanced prostate cancer noted among men with newly diagnosed disease.
More details are in "The natural history of prostate cancer," by Drs. Kessler and Albertsen, in the May 2003 Urologic Clinics of North America 30(2), pp. 219-226.