Evidence of overestimating prostate cancer mortality in Estonia: a population-based study

Innos, Kaire; Paapsi, Keiu; Alas, Indrek; Baum, Peep; Kivi, Martin; Kovtun, Mihhail; Okas, Rauno; Pokker, Helis; Rajevskaja, Olga; Rautio, Aleksandra; Saretok, Mikk; Valk, Elari; Žarkovski, M.; Denissov, Gleb; Lang, Katrin

doi:10.1080/21681805.2022.2119274

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…Our results are likely generalisable to countries with a similar public healthcare system to Sweden. Our results are in line with studies from Norway and Estonia, in which a third of PCa-related deaths were considered over-reported after expert committee review, exceeding 60% in men aged ≥90 years [13,14]. In an earlier population-based study from Sweden of men who died from PCa between 1987 and 1999, those aged >75 years at death and those with localised disease had a 5% excess of PCa-related death, when data were used from medical records compared to when data were used from the Cause of Death Register [15].…”

supporting

confidence: 91%

“…Furthermore, cancer mortality statistics are based on adjudicated cause of death, which is challenging in older men who often have multiple comorbidities [7][8][9]. Although several studies have shown that death certificates for men with PCa are highly accurate, many of these have been based on healthy, middle-aged men diagnosed in PCa screening trials who have been followed more closely than men with PCa in the general population [10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Evidence of cancer progression as the cause of death in men with prostate cancer in Sweden

et al. 2022

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To assess the strength of the evidence indicative of prostate cancer (PCa) progression as the adjudicated cause of death, according to age at death and PCa risk category. Patients and MethodsUsing data from the Prostate Cancer data Base Sweden, we identified a study frame of 5543 men with PCa registered as the cause of death according to the Cause of Death Register. We assessed the evidence of PCa progression through a review of healthcare records for a stratified sample of 495/5543. We extracted data on prostate-specific antigen levels, presence of metastases on imaging, and PCa treatments, and quantified the evidence of disease progression using a points system. ResultsBoth no evidence and moderate evidence for PCa progression was more common in men aged >85 years at death than those aged <85 years (29% vs 14%). Among the latter, the proportion with no evidence or moderate evidence for PCa progression was 21% for low-risk, 14% for intermediate-risk, 8% for high-risk, and 0% for metastatic PCa. In contrast, in men aged >85 years, there was little difference in the proportion with no evidence or moderate evidence of PCa progression between PCa risk categories; 31% for low-risk, 29% for intermediate-risk, 29% for high-risk, and 21% for metastatic PCa. Of the 5543 men who died from PCa, 13% (95% confidence interval 5-19%) were estimated to have either no evidence or moderate evidence of PCa progression. ConclusionsWeak evidence for PCa progression as cause of death was more common in older men with PCa and in those with low-risk PCa. This has implications for interpretation of mortality statistics especially when assessing screening and early treatment of PCa because the beneficial effect of earlier diagnosis could be masked by erroneous adjudication of PCa as cause of death in older men, particular those with localised disease at diagnosis.

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confidence: 91%

Section: Introductionmentioning

confidence: 99%

Evidence of cancer progression as the cause of death in men with prostate cancer in Sweden

et al. 2022

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“…Our results are applicable to other Western countries since both the proportion of men diagnosed with incident PCa at cystoprostatectomy and the proportion of men with latent PCa detected at autopsy are around 30% in many Western countries [23]. There is also evidence that the proportion of men who erroneously have PCa adjudicated as cause of death in the official cause of death registration is high in many countries [25][26][27].…”

Section: Discussionmentioning

confidence: 65%

“…Out of 328 men with PCa as adjudicated primary cause of death in The Cause of Death Register, a chart review could verify this in only 66% of the men. Similarly, in a recent study from Estonia, only 59% of deaths adjudicated to PCa were verified in a chart review [27].…”

Section: Discussionmentioning

confidence: 90%

Risk of prostate cancer death in men diagnosed with prostate cancer at cystoprostatectomy. A nationwide population-based study

Scilipoti,

Liedberg,

Garmo

et al. 2024

SJU

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Background and aims: One out of three men who undergo cystoprostatectomy for bladder cancer is diagnosed with incidental prostate cancer (PCa) at histopathological examination. Many of these men are PSA tested as part of their follow-up, but it is unclear if this is needed. The aim of this study was to assess the risk of PCa death in these men and the need of PSA-testing during follow-up. Methods: Between 2002 and 2020, 1,554 men were diagnosed with PCa after cystoprostatectomy performed for non-metastatic bladder cancer and registered in the National Prostate Cancer Register (NPCR) of Sweden. We assessed their risk of death from PCa, bladder cancer and other causes up to 15 years after diagnosis by use of data in The Cause of Death Register. The use of androgen deprivation therapy (ADT) as a proxy for PCa progression was assessed by fillings in The Prescribed Drug Register. Results: Fifteen years after diagnosis, cumulative incidence of death from PCa was 2.6% (95% CI 2.3%–2.9%), from bladder cancer 32% (95% CI: 30%–34%) and from other causes 40% (95% CI: 36%–44%). Only 35% of men with PCa recorded as primary cause of death in The Cause of Death Register had started ADT before date of death, indicating sticky-diagnosis bias with inflated risk of PCa death. Conclusions: For a large majority of men diagnosed with incidental PCa at cystoprostatectomy performed for bladder cancer, the risk of PCa death is very small so there is no rationale for PSA testing during follow-up.

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“…While lung cancer mortality declined by 9 % between 2011 and 2019, mortality from colorectal cancer increased by 2 % and mortality from prostate cancer increased by 10 %. However, recent evidence advises caution when interpreting prostate cancer mortality due to possible misattribution in assigning cause of death, leading to overestimation (Innos, 2022). Breast cancer mortality declined by 14 %, making it a large proportion of the overall decline in mortality in women (Figure 3).…”

Section: Overall Cancer Mortality In Estonia Has Remained Above the E...mentioning

confidence: 99%

EU Country Cancer Profile: Estonia 2023

2023

EU Country Cancer Profiles

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European Cancer Inequalities Registry Country Cancer Profile 2023Disclaimer: This work is published under the responsibility of the Secretary-General of the OECD. The opinions expressed and arguments employed herein do not necessarily reflect the official views of the Member countries of the OECD. This work was produced with the financial assistance of the European Union. The views expressed herein can in no way be taken to reflect the official opinion of the European Union. This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. Note by the Republic of Türkiye: The information in this document with reference to "Cyprus" relates to the southern part of the Island. There is no single authority representing both Turkish and Greek Cypriot people on the Island. Türkiye recognises the Turkish Republic of Northern Cyprus (TRNC). Until a lasting and equitable solution is found within the context of the United Nations, Türkiye shall preserve its position concerning the "Cyprus issue". Note by all the European Union Member States of the OECD and the European Union: The Republic of Cyprus is recognised by all members of the United Nations with the exception of Türkiye. The information in this document relates to the area under the effective control of the Government of the Republic of Cyprus.

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Evidence of overestimating prostate cancer mortality in Estonia: a population-based study

Cited by 5 publications

References 19 publications

Evidence of cancer progression as the cause of death in men with prostate cancer in Sweden

Evidence of cancer progression as the cause of death in men with prostate cancer in Sweden

Risk of prostate cancer death in men diagnosed with prostate cancer at cystoprostatectomy. A nationwide population-based study

EU Country Cancer Profile: Estonia 2023

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Evidence of overestimating prostate cancer mortality in Estonia: a population-based study

Cited by 5 publications

References 19 publications

Evidence of cancer progression as the cause of death in men with prostate cancer in Sweden

Evidence of cancer progression as the cause of death in men with prostate cancer in Sweden

Risk of prostate cancer death in men diagnosed with prostate cancer at cystoprostat­ectomy. A nationwide population-based study

EU Country Cancer Profile: Estonia 2023

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Risk of prostate cancer death in men diagnosed with prostate cancer at cystoprostatectomy. A nationwide population-based study