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Prostatic Cancer 30 Years After Bilateral Orchidectomy
BENIGN AND MALIGNANT NEOPLASMS OF THE PROSTATE
much larger for blacks than whites in younger age groups, when the prevalence of prostate cancer is relatively low. As a result, fewer blacks survive to older ages when age-specific prostate cancer rates are large. It is of note that blacks have higher incidence rates for prostate cancer than do whites at every age-specific interval. Hence, increasing trends in lifetime risk of prostate cancer suggest, in large part, longer life expectancy and better detection methods. Editorial Comment: This study provides valuable information on the lifetime risk of prostate cancer. Using incidence rates from 1975 to 1989 (estimates that are close to the levels that will eventually be reached once the peak from prostate specific antigen testing levels off), the lifetime risk of prostate cancer is 13.8% for white men and 12.5% for black men. This rate decreases to 11.3% for white and 11.8% for black men when adjusted for mortality rates from 1975 to 1977. These numbers are somewhat surprising. The incidence rate for prostate cancer in black men is approximately 40% higher than for white men and the mortality rate is almost double. However, because of higher comorbidity, black men do not live long enough for the peak incidence rates associated with old age. Thus, these data suggest that the lifetime risk for white and black men is actually similar. Patrick C. Walsh, M.D.
Prostatic Cancer 30 Years After Bilateral Orchidectomy M. UNO,T. DEGUCHI, H. EHARA, S. ISHIHARA AND S. KOBAYASHI, Departments of Urology, Kizawa Memorial Hospital and Gifu University School of Medicine, Gifu, Japan Brit. J. Urol., 81: 506-507, 1998 No Abstract Editorial Comment: A 79-year-oldman had undergone total penectomy, bilateral orchiectomy and inguinal lymph node dissection for advanced penile cancer when he was 49 years old. He presented with metastatic prostate cancer, a castrate level of testosterone and prostate specific antigen of 27. He had a brief response to diethylstilbestrol therapy but died 3 years following diagnosis. This article provides further evidence that castration following puberty does not prevent prostate cancer. There are similar findings in the dog. In a study of 13 dogs with prostate cancer 8 had been previously castrated.' Patrick C. Walsh, M.D. 1. Krawiec, D.R.and Heflin, D.: Study of prostatic disease in dogs: 177 cases (1981-1986). J. h e r . Veterin. Med. Assn., 200 119, 1992.
Prostate Cancer in Denmark A 50-Year Population-BasedStudy K. BRASSO,S. FRIIS, S. K. KJ~ER, T. J~RGENSEN AND P. IVERSEN, Department of Urology, Rigshospitalet, Danish Cancer Society, Division for Cancer Epidemiology and Department of Surgery, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark Urology, 51: 590-594, 1998 Objectives. To review the trends in prostate cancer (PC) incidence and mortality rates in Denmark during a 50-year period. Methods. A population-based register study was performed of all new cases of PC recorded in the Danish Cancer Registry from 1943 to 1992. Results. The age-standardized incidence rate for PC increased from 11.5/100,000 in 1943 to 1947 to 30.9/100,000 in 1988 to 1992, Age-specific incidence rates increased in all age groups over 50 years of age. Mortality rates increased from 13.5/100,000 in 1953 to 1957 to 17.8/100,000 in 1988 to 1992. No major changes in the distribution of age, stage at the time of diagnosis, or in diagnostic procedures were found, indicating that the observed change in incidence rates was not caused by attempted early detection or changes in diagnostic strategy. Conclusions. Our data suggest that the increased PC incidence observed during the period of cancer registration in Denmark represents a true increase in the number of patients with clinical PC. Editorial Comment: Denmark has maintained a conservative attitude toward the early diagnosis and treatment of prostate cancer. Thus, the increase in age adjusted incidence and mortality from prostate cancer suggests that there may be a true increase in the number of men with clinical prostate cancer. This trend may also be present in the United States but it is obscured by improved methods of detection and diagnosis. Patrick C. Walsh,M.D.
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much larger for blacks than whites in younger age groups, when the prevalence of prostate cancer is relatively low. As a result, fewer blacks survive to older ages when age-specific prostate cancer rates are large. It is of note that blacks have higher incidence rates for prostate cancer than do whites at every age-specific interval. Hence, increasing trends in lifetime risk of prostate cancer suggest, in large part, longer life expectancy and better detection methods. Editorial Comment: This study provides valuable information on the lifetime risk of prostate cancer. Using incidence rates from 1975 to 1989 (estimates that are close to the levels that will eventually be reached once the peak from prostate specific antigen testing levels off), the lifetime risk of prostate cancer is 13.8% for white men and 12.5% for black men. This rate decreases to 11.3% for white and 11.8% for black men when adjusted for mortality rates from 1975 to 1977. These numbers are somewhat surprising. The incidence rate for prostate cancer in black men is approximately 40% higher than for white men and the mortality rate is almost double. However, because of higher comorbidity, black men do not live long enough for the peak incidence rates associated with old age. Thus, these data suggest that the lifetime risk for white and black men is actually similar. Patrick C. Walsh, M.D.
Prostatic Cancer 30 Years After Bilateral Orchidectomy M. UNO,T. DEGUCHI, H. EHARA, S. ISHIHARA AND S. KOBAYASHI, Departments of Urology, Kizawa Memorial Hospital and Gifu University School of Medicine, Gifu, Japan Brit. J. Urol., 81: 506-507, 1998 No Abstract Editorial Comment: A 79-year-oldman had undergone total penectomy, bilateral orchiectomy and inguinal lymph node dissection for advanced penile cancer when he was 49 years old. He presented with metastatic prostate cancer, a castrate level of testosterone and prostate specific antigen of 27. He had a brief response to diethylstilbestrol therapy but died 3 years following diagnosis. This article provides further evidence that castration following puberty does not prevent prostate cancer. There are similar findings in the dog. In a study of 13 dogs with prostate cancer 8 had been previously castrated.' Patrick C. Walsh, M.D. 1. Krawiec, D.R.and Heflin, D.: Study of prostatic disease in dogs: 177 cases (1981-1986). J. h e r . Veterin. Med. Assn., 200 119, 1992.
Prostate Cancer in Denmark A 50-Year Population-BasedStudy K. BRASSO,S. FRIIS, S. K. KJ~ER, T. J~RGENSEN AND P. IVERSEN, Department of Urology, Rigshospitalet, Danish Cancer Society, Division for Cancer Epidemiology and Department of Surgery, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark Urology, 51: 590-594, 1998 Objectives. To review the trends in prostate cancer (PC) incidence and mortality rates in Denmark during a 50-year period. Methods. A population-based register study was performed of all new cases of PC recorded in the Danish Cancer Registry from 1943 to 1992. Results. The age-standardized incidence rate for PC increased from 11.5/100,000 in 1943 to 1947 to 30.9/100,000 in 1988 to 1992, Age-specific incidence rates increased in all age groups over 50 years of age. Mortality rates increased from 13.5/100,000 in 1953 to 1957 to 17.8/100,000 in 1988 to 1992. No major changes in the distribution of age, stage at the time of diagnosis, or in diagnostic procedures were found, indicating that the observed change in incidence rates was not caused by attempted early detection or changes in diagnostic strategy. Conclusions. Our data suggest that the increased PC incidence observed during the period of cancer registration in Denmark represents a true increase in the number of patients with clinical PC. Editorial Comment: Denmark has maintained a conservative attitude toward the early diagnosis and treatment of prostate cancer. Thus, the increase in age adjusted incidence and mortality from prostate cancer suggests that there may be a true increase in the number of men with clinical prostate cancer. This trend may also be present in the United States but it is obscured by improved methods of detection and diagnosis. Patrick C. Walsh,M.D.
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