Trends in incidence and mortality rates for prostate cancer before and after prostate-specific antigen introduction. A registry-based study in Southeastern Netherlands, 1971–1995

Trend and Variation in Treatment of Localized Prostate Cancer in the Southern Part ofThe Netherlands, 1988–1996

“…The proportional increase in localized tumors is most likely due to increasing opportunistic PSA testing, which resulted in an increase in the age-adjusted incidence in southeastern Netherlands from 55 per 10 5 in 1990 to 80 per 10 5 in 1995, the increase representing mainly localized cases [4]. This would explain why T2 tumors increased in particular: besides small palpable tumors, this category represents tumors that were not palpable, but visible on transrectal ultrasound, e.g.…”

“…Initially, the registry started in the southeastern part, as described in detail elsewhere [9], and can be considered virtually complete for prostate cancer since 1971 [4]. Registration in the southwestern part, using similar methods as in the southeastern part, was completed in 1988.…”

“…Nevertheless, the large increase in the incidence of early prostate cancer in the 1980s resulted in an even more pronounced increase in the use of radical prostatectomy in the USA [2]. In The Netherlands, the incidence, mainly of lowgrade prostate cancer, increased by almost 50% following the introduction of prostate-specific antigen (PSA) testing in the 1990s [3,4]. Curative treatment is not necessarily Post/Kil/Hendrikx/Poortmans/Crommelin/ Coebergh the optimal treatment option for all these patients due to the protracted natural history and the frequently occurring concomitant diseases with a negative impact on the life expectancy of these patients [5].…”

Incidence and mortality trends for prostate cancer in 5 French areas from 1982 to 1996

“…However, to minimize this "exhaustivity effect," the registries included in the study have been chosen given their first year of activity, which might be anterior to 1980, excepted for the Tarn, which began his registration in 1982; Figure 1 shows that the incidence rates in this area are roughly similar to the others. The little acceleration in the incidence trend that began in the mid1980s, already described in several countries, 4,5,12,13 is probably the result of the screening using PSA.…”

“…1 Prostate cancer became the most frequently diagnosed cancer in males after an important increase in detection, notably in relation with the development of screening by serum Prostate-Specific Antigen assay (PSA) and digital rectal examination. [2][3][4][5] This screening remains controversial for several reasons: the main reasons are incomplete knowledge regarding the natural history of this disease, 6 the problems linked to the uncertainties concerning treatment indications in the early stages of the disease 6 -8 and the fact that this screening has not proved effective in terms of public health. 9,10 To our knowledge, only 1 randomized study has been published on the effect on mortality of mass screening for prostate cancer 11 in which the authors found a decrease of 67.1% in prostate cancer mortality in the screened group compared with the control group.…”