International trends and patterns of prostate cancer incidence and mortality

Abstract

Prostate cancer is the most commonly diagnosed cancer in western men, and incidence is rising rapidly in most countries, including low-risk populations. Age-adjusted incidence and mortality rates from 15 and 13 countries between 1973-77 and 1988-92, respectively, were compared to provide leads for future analytic studies. Large increases in both incidence and mortality rates of prostate cancer were seen for all countries. For incidence, increases were more pronounced in the United States, Canada, Australia, France and the Asian countries, while the increases in medium-risk countries were moderate. Increases in incidence ranged from 25%-114%, 24%-55% and 15%-104% in high-, medium-and low-risk countries, respectively. Mortality rates rose more rapidly in Asian countries than in high-risk countries. Substantial differences in incidence and mortality across countries were evident, with U.S. blacks having rates that were 50-60 times higher than the rates in Shanghai, China. Increasing incidence rates in the United States and Canada are likely to be due in part to the widespread use of transurethral resection of the prostate and prostate-specific antigen testing, while increases in the Asian countries are probably related to westernization in these low-risk populations. The large disparities in incidence between high-and low-risk countries may be due to a combination of genetic and environmental factors. Prostate cancer is the most commonly diagnosed cancer among men in most western countries (Parkin et al., 1997). With the aging of the population and increased prostate cancer screening, especially the use of prostate-specific antigen (PSA), the incidence of prostate cancer in the United States and certain western countries has risen sharply during the last decade (Potosky et al., 1995;Mercer et al., 1997;Majeed and Burgess, 1994;Weller et al., 1998). In the United States, the rapid increase in incidence since the introduction of PSA in 1986 has resulted in a lower median age at diagnosis (decreased by 1 year in both blacks and whites) and an earlier stage of cancer at diagnosis, although the benefit of screening on prostate cancer mortality rates remains undetermined (Prorok et al., 1996). Prostate cancer rates in Asian countries, such as China and Japan, are much lower than those reported in western populations (U.S. rates are 50-60 times higher), but they appear to be increasing rapidly as well (Nakata et al., 1995;Hsing et al., 1998). In this report, we examine trends and patterns of incidence and mortality during a 20-year period (from 1973-77 to 1988-92) in more than a dozen countries to provide clues for future studies. MATERIAL AND METHODS Incidence dataWe retrieved age-specific and standardized incidence rates per 100,000 man-years, age-adjusted to the world standard, for prostate cancer during the 20-year period (1973-77 to 1988-92) in 15 countries from 4 volumes (IV-VII) of publications from the International Agency for Research on Cancer (IARC), Cancer Incidence in 5 Continents, covering the time periods ...

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