Prostate cancer incidence and mortality trends in 37 European countries: An overview

Abstract

Prostate cancer has emerged as the most frequent cancer amongst men in Europe, with incidence increasing rapidly over the past two decades. Incidence has been uniformly increasing in the 24 countries with comparable data available, although in a few countries with very high rates (Sweden, Finland and The Netherlands), incidence has begun to fall during the last 3–4 years. The highest prostate cancer mortality rates are in the Baltic region (Estonia, Latvia and Lithuania) and in Denmark, Norway and Sweden. Prostate cancer mortality has been decreasing in 13 of the 37 European countries considered – predominantly in higher-resource countries within each region – beginning in England and Wales (1992) and more recently in the Czech Republic (2004). There was considerable variability in the magnitude of the annual declines, varying from approximately 1% in Scotland (from 1994) to over 4% for the more recent declines in Hungary, France and the Czech Republic. There appears little relation between the extent of the increases in incidence (in the late 1990s) and the recent mortality declines. It remains unclear to what extent the increasing trends in incidence indicate true risk and how much is due to detection of latent disease. The decreasing mortality after 1990 may be attributable to improvements in treatment and to an effect of prostate specific antigen (PSA) testing. The increase in mortality observed in the Baltic region and in several Central and Eastern European countries appear to reflect a real increase in risk and requires further monitoring.

Introduction

Prostate cancer has become the most common non-skin cancer neoplasm amongst men in Europe, with an estimated 382,000 cases occurring in 2008.¹ Incidence has increased rapidly over the past two decades, and rates are influenced by early diagnosis by prostate specific antigen (PSA) testing amongst men, with or without symptoms, as well as by the detection of latent cancer in prostate surgery. PSA testing has been particularly common in certain Northern and Western European countries, an observation likely to explain much of the eightfold variation in incidence rates in Europe around 2000, with rates highest in Tyrol, Austria and lowest in Serbia.²

Almost 90,000 deaths from prostate cancer were estimated to have occurred in 2008 in Europe, ranking it the third most common cause of cancer death amongst men, after lung and colorectal cancers.¹

The mortality rate is less affected by early diagnosis of asymptomatic cancers, and consequently the high death rates in the Nordic countries are five times those seen in several Central and Eastern European countries (such as Serbia, Russia and the Ukraine), where rates have been relatively low for decades.

This study aims to describe comprehensively the overall trends in prostate cancer incidence and mortality rates in 37 European countries by region, using published incidence data from population-based national and regional cancer registries and national death rates from the World Health Organisation (WHO) mortality databank. The temporal trends in rates are compared and discussed in light of the recent impact – within the last 15 years – of treatment with curative intent versus that of PSA testing, subsequent biopsy and treatment on mortality.