Beyond the Abstract - Potential years of life lost due to urogenital cancer in the United States: Trends from 1972 to 2006 based on data from the SEER database, by Mohamed H. Kamel, MD, et al

BERKELEY, CA (UroToday.com) - In this study, we assessed potential years of life lost (PYLL) secondary to genitourinary cancer in the United States, from 1972 to 2006, using the SEER (Surveillance, Epidemiology and End Results) database. Potential years of life lost up to and including age 75 years were calculated by and across genders in 5-year increments between 1972 and 2006.

A total of 7.73 million potential years of life were lost in men and women. In each gender, the greatest potential loss was for kidney and renal pelvis cancer related mortality. It seems that early detection and aggressive treatment of kidney cancer did not change the trend in PYLL. This may be explained by a lead time bias similar to the one observed in prostate cancer. Also the lack of effective systemic therapy may also be a contributing factor.

In each gender, no improvement in the PYLL due to ureteral and bladder cancer related mortality was observed during 3 decades. This may be explained by the lack of breakthrough progress in bladder cancer treatment. For 3 decades BCG has been the treatment of choice for non-invasive bladder cancer. Also, there has been no improvement in disease survival after radical cystectomy in contemporary literature with most of the new chemotherapeutic regimens focusing on reducing side effects rather than improving survival.

In males, the greatest decrease in potential years of life lost was for testicular cancer. Contemporary literature shows that patients with seminomatous germ cell tumor have 90% overall survival for all stages combined. Those with early and advanced stage nonseminomatous germ cell tumor have a cure rate of 95% and 70%, respectively. The current multimodal treatment approach for testicular cancer has contributed largely to these findings.

In prostate cancer, we have noticed that the PYLL increased in the first 2 decades, then declined in the second 2 decades. This may be explained by the wider use of radical prostatectomy with improved incontinence rates and the advancement in radiotherapy techniques. Whether PSA screening is a factor or not in explaining these observations will continue to be the subject of intense debate.

Penile cancer is a rare cancer. The overall trend in PYLL secondary to penile cancer appears to be decreasing. This may reflect decreasing incidence, widespread circumcision, vaccination of females against human papillomavirus, and improved survival with aggressive surgical treatment of the primary lesion and inguinal lymphadenectomy.

In conclusion, there has been an increasing trend in potential years of life lost related to urogenital cancer during the last 35 years for both males and females. This trend is mainly due to an increase in kidney cancer. The continued increase in potential years of life lost due to renal cancer and the lack of a decrease in the loss in those with bladder cancer should alert urologists and health care policy makers to deficient areas that most need to be addressed.

Written by:
Mohamed H. Kamel, Page C. Moore, Nabil K. Bissada, and Samy M. Heshmat as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Potential years of life lost due to urogenital cancer in the United States: Trends from 1972 to 2006 based on data from the SEER database - Abstract

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