BACKGROUND: The incidence of @entity263 was relatively flat until 1991 and then started declining rapidly. This decline probably was caused by the shift to earlier stage disease associated with the rapid dissemination of @entity1486 (PSA) screening. @entity263 mortality rates started falling at approximately the same time. In this article, the authors model the potential impact of this stage shift on @entity263 mortality rates given various assumptions concerning the survival of @entity1 with screen-detected local-regional disease. METHODS: The authors used the CAN*TROL 2 computer model to shift each deficit in the number of @entity1 with distant stage disease to local-regional stage disease and modeled the implications on mortality using a set of base, optimistic, and pessimistic survival assumptions. A base survival assumes that a @entity1 with screen-detected local-regional disease of a certain histologic grade has the same prognosis as a @entity1 with clinically detected local-regional disease of same grade (i.e., an assumption of no length bias for @entity1 with screen-detected disease), whereas the optimistic and pessimistic scenarios assume that survival is better or worse, respectively, than the base survival (i.e., complete cure for @entity1 with favorable grade for the optimistic scenario and no improvements in survival for @entity1 with unfavorable grade for the pessimistic scenario). RESULTS: Model results were compared with observed mortality trends. Rising age-adjusted mortality rates peaked in 1991 for white males and in 1993 for black males and then fell 21% and 13% for white males and black males, respectively, from 1990 through 1999. Under the modeled stage-shift intervention, mortality rates would fall 18%, 8%, and 19% for both white males and black males under the base, pessimistic, and optimistic assumptions, respectively. CONCLUSIONS: It is impossible to know what the mortality trends would have been in the absence of the introduction of PSA screening. However, under the base assumption, it appears that the decline in distant stage disease can have a fairly sizable and rapid impact on population mortality. The optimistic scenario is not much improved over the base scenario, which is indicative of the facts that the survival of @entity1 diagnosed with clinical local-regional @entity263 is quite good and that further survival improvements can have only a marginal impact. Under the pessimistic scenario, it appears that something else must be responsible for much of the decline in mortality. Screening trial results from the United States and Europe may verify and isolate the size of any mortality benefit associated with PSA screening. Trial results eventually can be put back into these population models to help quantify the impact of screening, treatment, and other factors on population trends.

Modeling the impact of the decline in distant stage disease on XXXX mortality rates.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity263 :: ('MESH:D011471', 'Disease') :: ['Prostate carcinoma', 'distant stage prostate carcinoma', 'prostate carcinoma'] @entity1486 :: ('354', 'Gene') :: ['prostate specific antigen']
@entity263 :: (MESH:D011471,Disease) :: ['prostate carcinoma']
