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Show Radical Prostatectomy Radiation -1-' c -Lvyu /o -80% | CD i r*-¦ m CD ^^"^ h-UO 60% - C \ \ CD v\ o CD cr \ ¦ CD 40% - \ T •00 c \ \ CD O CD CL 20% - 0% - 100% -, 80% - 60% - 40% - 20% - 40- 45- 50- 55- 60- 65- 70- 75- 80- 85+ 44 49 54 59 64 69 74 79 84 40- 45- 50- 55- 60- 65- 70- 75- 80- 85+ 44 49 54 59 64 69 74 79 84 Age Cohort Age Cohort Utah -X-SEER (excluding Utah) Figure 2. Percentage of histologically confirmed local/regional malignant prostate cancer cases among white men in Utah and SEER (excluding Utah) by treatment and age cohort. among cases tends to occur across age groups and specific SEER registries. In addition, use of radical prostatectomy exceeds that of radiation therapy for older age groups in Utah than in SEER (excluding Utah). A possible explanation for the relatively high use of radical prostatectomy and low use of radiation, at least in part, may be attributed to better general health in the Utah population such that men are better candidates for radical prostatectomy. In particular, radical prostatectomy is usually reserved for patients in good health, with a life expectancy greater than 10 to 15 years, and who elect this intervention (Catalona & Bigg, 1990; Nadler & Andriole, 1996; Steinberg, Bales, & Brendler, 1998). Several reports have identified relatively low disease rates (e.g., cancer and heart disease) and high life expectancy in Utah (Utah: Burden of Chronic Diseases, 1996). Good general health in Utah may partially be explained by the historically low smoking rates (Merrill, 1999). In 2000, the percentage of adult smokers in Utah was 12.9% compared with 17.2% in California and 24.2% nationally (Nationwide Tobacco Use, 2000). At the outset of this paper, we referred to the ongoing debate over the efficacy of prostate cancer treatment. Resolving this debate is unlikely in the near future because it is currently difficult to determine whether a man with prostate cancer will eventually manifest clinical symptoms, whether the cancer is progressive such that clinical symptoms will occur, or whether the cancer is rapidly progressive in such a way that a very short preclinical period exists. Waterbor and Bueshen (1995) estimated from U.S. data the percentage of prostate cancer in each of these groups as 91%, 8%, and 1%, respectively. Men who are most likely to benefit from screen detection and aggressive treatment are those with a progressive form of the disease. Screen-detected cases with nonprogressive disease who are aggressively treated will not benefit from the treatment. Men with rapidly progressive prostate cancer are unlikely to benefit from aggressive treatment because of the relatively short preclinical phase of the tumor. The debate is further fueled by complications that may arise from the surgery. About one third of patients receiving a radical prostatectomy with curative intent require follow-up cancer treatments (Davidson, van den Ouden, Schroeder, 1996; Lit win et al., 1998; Lu-Yao et al., 1996). Morbidity and mortality rates associated with this surgery are common, increasingly so with older age (Imperato, Nen- Utah's Health: An Annual Review Volume VIII |