Trends in prostate cancer incidence and mortality to monitor control policies in a northeastern Brazilian state

Prostate cancer differently affects different regions of the world, displaying higher rates in more developed areas. After the implementation of prostate-specific antigen (PSA) testing, several studies described rising rates globally, but it is possible that indolent lesions are being detected given the lack of changes in mortality data. The Brazilian government recommends against PSA screening in the male population regardless of age, but the Urology Society issued a report recommending that screening should start at 50 years old for certain men and for those aged ≥75 years with a life expectancy exceeding 10 years. In this study, we examined the incidence and mortality rates of invasive prostate cancer over time in the Sergipe state of Brazil. The databases of the Aracaju Cancer Registry and Mortality Information System were used to calculate age-standardized rates for all prostate tumors (International Classification of Diseases 10th edition: C61 and D07.5) in the following age ranges: 20–44, 45–54, and ≥65 years. We identified 3595 cases of cancer, 30 glandular intraepithelial high-grade lesions, and 3269 deaths. Using the Joinpoint Regression Program, we found that the incidence of prostate cancer dramatically increased over time until the mid-2000s for all age groups, after which the rates declined. Prostate cancer mortality rates increased until 2005, followed by a non-significant annual percent change of 22.0 in 2001–2005 and a stable rate thereafter. We noticed that the increases and decreases of the incidence rates of prostate cancer were associated with the screening recommendations. Meanwhile, the increased mortality rates did not appear to be associated with decreased PSA testing; instead, they were linked to the effects of age and improvements in identification of the cause of death. Thus, we do not believe a PSA screening program would benefit the population of this study.

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Age specific trends in prostate cancer tests, incidence and mortality in Australia since the introduction of the Prostate Specific Antigen (PSA) test

10.21203/rs.3.rs-15620/v1 ◽

2020 ◽

Author(s):

Thanya Pathirana ◽

Rehan Sequeira ◽

Chris Del Mar ◽

James A Dickinson ◽

Katy J L Bell ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Incidence ◽

Specific Antigen ◽

Age Groups ◽

Prostate Cancer Incidence ◽

Psa Screening ◽

Prostate Biopsies ◽

Psa Testing ◽

Incidence And Mortality ◽

Incidental Cancer

Abstract BackgroundPopulation trends in PSA screening and prostate cancer incidence do not perfectly correspond. We aimed to better understand relationships between trends in PSA screening, prostate cancer incidence and mortality in Australia.MethodsDescription of age standardised time trends in PSA tests, prostate biopsies, cancer incidence and mortality within Australia for the age groups: 45-74, 75-84, and 85+ years.ResultsPSA testing increased from its introduction in 1989 to a peak in 2008. It then declined in men aged 45-84 years. Prostate biopsies and cancer incidence declined from 1995 to 2000, in parallel with decrease in trans-urethral resections of prostate (TURP). After 2000, changes in biopsies and cancer incidence paralleled PSA screening in men 45-84 years, while in men ≥85 years, biopsies stabilised and incidence declined. More recently a reduction in TURP correlated with increased Dutasteride and Tamsulosin usage. Prostate cancer mortality in men aged 45-74 years remained low throughout. Mortality in men 75-84 years gradually increased until the mid 1990s, then gradually decreased. Mortality in men ≥85 years increased until the mid 1990s, then stabilised.ConclusionsAge specific prostate cancer incidence largely mirrors PSA screening rates. Most deviation may be explained by changes in management of benign prostatic disease and incidental cancer detection. The timing of the small mortality reduction in men 75-84 years is more consistent with benefits from advances in treatment than with early detection through PSA. The large increases in prostate cancer incidence with minimal changes in mortality suggest overdiagnosis.

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Global Trends and Prostate Cancer: A Review of Incidence, Detection, and Mortality as Influenced by Race, Ethnicity, and Geographic Location

American Journal of Men s Health ◽

10.1177/1557988318798279 ◽

2018 ◽

Vol 12 (6) ◽

pp. 1807-1823 ◽

Cited By ~ 89

Author(s):

Harold Evelyn Taitt

Keyword(s):

Prostate Cancer ◽

Treatment Guidelines ◽

Disease Incidence ◽

Specific Antigen ◽

Geographic Location ◽

Mortality Rates ◽

European Ancestry ◽

Psa Testing ◽

Incidence And Mortality ◽

Race Ethnicity

Although research has reported that prostate cancer (PCa) incidence and mortality rates are among the highest for African Americans, the data is inconclusive regarding PCa rates in native African men, Black men residing in other countries, and men in Asia, Europe, and the Americas. Data reveals that prostate-specific antigen (PSA) testing and disease incidence have risen significantly in developing and Asian countries, and PCa has become one of the leading male cancers in many of those nations. The objective of this study was to review published peer-reviewed studies that address PCa in different regions of the world to get a better understanding of how PCa incidence, prevalence, detection, and mortality are influenced by race, ethnicity, and geography. A secondary goal was to compare PCa data from various world regions to contextualize how disproportionate the incidence and mortality rates are among men from the African diaspora versus men of European, Hispanic, and Asian descent, as well as to highlight the need for more robust screening and treatment guidelines in developing countries. There are differences in incidence and mortality rates between men of African, Asian, Hispanic, and European ancestry, confirming the involvement of genetic factors. However, differences between men of the same race and ethnicity who live in different countries suggest that environmental factors may also be implicated. Availability and access to diagnostic and health-care services as well as recommendations regarding PCa testing vary from country to country and contribute to the variability in incidence and mortality rates.

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Differences in Prostate Cancer Incidence and Mortality in Lower Saxony (Germany) and Groningen Province (Netherlands): Potential Impact of Prostate-Specific Antigen Testing

Frontiers in Oncology ◽

10.3389/fonc.2021.681006 ◽

2021 ◽

Vol 11 ◽

Author(s):

Sanny Kappen ◽

Geertruida H. de Bock ◽

Eunice Sirri ◽

Claudia Vohmann ◽

Joachim Kieschke ◽

...

Keyword(s):

Prostate Cancer ◽

The Netherlands ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

Mortality Rates ◽

Incidence Rates ◽

Lower Saxony ◽

Psa Testing ◽

Incidence And Mortality ◽

The Mean

BackgroundProstate cancer (PCa) is the most frequent cancer among men in Europe. Differences in PCa incidence around the world can be partly explained by variations in recommendations for prostate-specific antigen (PSA), particularly for early detection. For example, the PSA testing policy is more conservative in the Netherlands than in Germany. To better understand the relationship between PSA testing recommendations and PCa incidence, stage distribution, and mortality, we compared these variables over time between Lower Saxony in northwestern Germany and the neighboring province of Groningen in the Netherlands.MethodsPopulation data, tumor stage- and age group-specific PCa incidence (ICD-10 C61) and mortality rates for Lower Saxony and Groningen were obtained from the Lower Saxony Epidemiological Cancer Registry, the Netherlands Comprehensive Cancer Organization, and Statistics Netherlands for 2003–2012. Incidence and mortality rates per 100,000 person-years were age-standardized (ASR, old European standard). Trends in age-standardized incidence rates (ASIR) and mortality rates (ASMR) for specific age groups were assessed using joinpoint regression.ResultsThe mean annual PCa ASIR between 2003 and 2012 was on average 19.9% higher in Lower Saxony than in Groningen (120.5 vs. 100.5 per 100,000), while the mean annual ASMR was on average 24.3% lower in Lower Saxony than in Groningen (21.5 vs. 28.4 per 100,000). Between 2003 and 2012, the average annual percentage change (AAPC) in PCa incidence rates did not change significantly in either Lower Saxony (−1.8%, 95% CI −3.5, 0.0) or Groningen (0.2%, 95% CI −5.0, 5.7). In contrast, the AAPC in mortality rate decreased significantly during the same time period in Lower Saxony (−2.5%, 95% CI −3.0, −2.0) but not in Groningen (0.1%, 95% CI −2.4, 2.6).ConclusionsHigher PCa incidence and lower PCa-related mortality was detected in Lower Saxony than in Groningen. Although recommendations on PSA testing may play a role, the assessed data could not offer obvious explanations to the observed differences. Therefore, further investigations including data on the actual use of PSA testing, other influences (e.g., dietary and ethnic factors), and better data quality are needed to explain differences between the regions.

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Trends in Prostate Specific Antigen (PSA) testing and prostate cancer incidence and mortality in Australia: A critical analysis

Cancer Epidemiology ◽

10.1016/j.canep.2021.102093 ◽

2022 ◽

Vol 77 ◽

pp. 102093

Author(s):

Thanya Pathirana ◽

Rehan Sequeira ◽

Chris Del Mar ◽

James A. Dickinson ◽

Bruce K. Armstrong ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Cancer Incidence ◽

Critical Analysis ◽

Specific Antigen ◽

Prostate Cancer Incidence ◽

Psa Testing ◽

Incidence And Mortality

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PSA screening for prostate cancer

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.63.08.722 ◽

2017 ◽

Vol 63 (8) ◽

pp. 722-725 ◽

Cited By ~ 2

Author(s):

Marcus V. Sadi

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Early Diagnosis ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

Low Grade ◽

Psa Screening ◽

Psa Testing ◽

Baseline Values

Summary Screening of prostate cancer with prostate-specific antigen (PSA) is a highly controversial issue. One part of the controversy is due to the confusion between population screening and early diagnosis, another derives from problems related to the quality of existing screening studies, the results of radical curative treatment for low grade tumors and the complications resulting from treatments that affect the patient’s quality of life. Our review aimed to critically analyze the current recommendations for PSA testing, based on new data provided by the re-evaluation of the ongoing studies and the updated USPSTF recommendation statement, and to propose a more rational and selective use of PSA compared with baseline values obtained at an approximate age of 40 to 50 years.

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Current and Future Burden of Prostate Cancer in Songkhla, Thailand: Analysis of Incidence and Mortality Trends From 1990 to 2030

Journal of Global Oncology ◽

10.1200/jgo.17.00128 ◽

2018 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Christian S. Alvarez ◽

Shama Virani ◽

Rafael Meza ◽

Laura S. Rozek ◽

Hutcha Sriplung ◽

...

Keyword(s):

Prostate Cancer ◽

Birth Cohort ◽

Developed Countries ◽

Mortality Rates ◽

Incidence Rates ◽

Mortality Trends ◽

Annual Percent Change ◽

Public Health Burden ◽

Incidence And Mortality ◽

Using Data

Purpose Prostate cancer is the second most common malignancy among men worldwide, and it poses a significant public health burden that has traditionally been limited mostly to developed countries. However, the burden of the disease is expected to increase, affecting developing countries, including Thailand. We undertook an analysis to investigate current and future trends of prostate cancer in the province of Songkhla, Thailand, using data from the Songkhla Cancer Registry from 1990 to 2013. Methods Joinpoint regression analysis was used to examine trends in age-adjusted incidence and mortality rates of prostate cancer and provide estimated annual percent change (EAPC) with 95% CIs. Age-period-cohort (APC) models were used to assess the effect of age, calendar year, and birth cohort on incidence and mortality rates. Three different methods (Joinpoint, Nordpred, and APC) were used to project trends from 2013 to 2030. Results Eight hundred fifty-five cases of prostate cancer were diagnosed from 1990 to 2013 in Songkhla, Thailand. The incidence rates of prostate cancer significantly increased since 1990 at an EAPC of 4.8% (95% CI, 3.6% to 5.9%). Similarly, mortality rates increased at an EAPC of 5.3% (95% CI, 3.4% to 7.2%). The APC models suggest that birth cohort is the most important factor driving the increased incidence and mortality rates of prostate cancer. Future incidence and mortality of prostate cancer are projected to continue to increase, doubling the rates observed in 2013 by 2030. Conclusion It is critical to allocate resources to provide care for the men who will be affected by this increase in prostate cancer incidence in Songkhla, Thailand, and to design context-appropriate interventions to prevent its increasing burden.

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Increasing use of radical prostatectomy for lower-risk prostate cancer in Denmark.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.149 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 149-149

Author(s):

M. Andreas Roeder ◽

Klaus Brasso ◽

Ib Jarle Christensen ◽

Jorgen Johansen ◽

Niels Christian Langkilde ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Lower Risk ◽

Nordic Country ◽

Specific Antigen ◽

Trend Test ◽

Gleason Grade ◽

Psa Testing ◽

Age At Surgery ◽

Over Time

149 Background: Denmark introduced radical prostatectomy (RP) as the last Nordic country in 1995. Since then, a rapid increment in the Danish incidence of prostate cancer (PCa) is indicative of increasing opportunistic prostate-specific antigen (PSA) testing. We hypothesized that an increasing proportion of men undergo RP for lower-risk PCa. Methods: All patients undergoing RP in Denmark between 1995 and 2011 were included. Changes over time in age at surgery, preoperative PSA, clinical T-category, biopsy Gleason score (GS) are described. Tests for statistically significant changes in trends were performed using linear regression and Cochran-Armitage trend test. Results: Median age at surgery increased from 61.4 to 64.8 (p<0.0001) during the 16 year period. Median preoperative PSA declined from 11.5 to 7.9 ng/ml (p<0.0001). Distribution of biopsy GS changed significantly, especially after 2005. Biopsy GS=7 was found in 20.2% of the patients in 2005 compared to 57.1% in 2011. The proportion of T1 disease increased from 32% to 56%. The proportion of patients above age 65 increased from 26.8% to 48.3% in the 16 year period studied. To adjust for grade, PSA, and age migration, we analyzed changes in the proportion of men age over age 65, with PSA less than or equal to 10 ng/ml, biopsy GS≤3+4, and clinical T1 disease over time. In the 16 year period, this proportion increased from 2% to 16% (p<0-001) of the cohort undergoing RP in Denmark. Conclusions: Significant preoperative age, stage, and Gleason grade migration was found in this complete Danish nation-wide cohort of patients undergoing RP during the past 16 years. This has occurred in the absence of any major changes to the national Danish guidelines for diagnosis and treatment of localized PCa. This effect is likely attributed to an increasing use of PSA although national guidelines recommend against PSA screening. Further, new guidelines from the International Society of Urological Pathology have had a major impact on risk classification. According to recently published randomized trials, the risk of overtreatment of localized PCa with RP is an increasing problem in Denmark.

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Improvement In Colorectal Cancer Outcomes Over Time is Limited To Patients With Left-Sided Disease

10.21203/rs.3.rs-1015558/v1 ◽

2021 ◽

Author(s):

Holger Rumpold ◽

Monika Hackl ◽

Andreas Petzer ◽

Dominik Wolf

Keyword(s):

Colorectal Cancer ◽

Primary Tumor ◽

Mortality Rates ◽

Tumor Location ◽

Mortality Data ◽

Cancer Outcomes ◽

Data Set ◽

Primary Tumor Location ◽

Incidence And Mortality ◽

Over Time

Abstract Purpose: Incidence and mortality of colorectal cancer (CRC) declined over the last decades. However, survival depends on the primary tumor location. It is unknown if all progress in outcomes vary depending on left-sided (LCRC) versus right sided (RCC) colorectal cancer. We compare incidence and mortality rates over time according to the primary tumor location. Methods: Data from the Austrian National Cancer Registry spanning from 1983 to 2018 were used to calculate annual incidence and mortality rates and survival stratified by primary tumor localization and stage. Joinpoint regression with linear regression models were used on different subgroups to identify significant changes of incidence- and mortality slopes.Results: A total of 168,260 (incidence-data set) and 87,355 cases (mortality data-set) were identified. Survival of disseminated RCC was worse compared to LCRC (HR 1.14; CI 1.106 – 1.169). Total and LCRC incidence- and mortality-rates declined steadily over time, whereas the rates of RCC did not. Incidence of disseminated RCC declined significantly less (slope -0.07; CI -0.086; -0.055) than in LCRC (slope -0.159; CI -0.183; -0.136); mortality rate of RCC was unchanged over time. Incidence and mortality of localized RCC remained unchanged over time, whereas both rates declined independently of stage in LCRC. Conclusion: Colorectal cancer outcomes during the last 35 years have preferentially improved in LCRC but not in RCC, indicating that the progress made is limited to LCRC. It is necessary to define RCC as a distinct form of CRC and to focus on specific strategies for its early detection and treatment.

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10-Year Outcomes After Monitoring, Surgery, or Radiotherapy

50 Studies Every Urologist Should Know ◽

10.1093/med/9780190655341.003.0008 ◽

2021 ◽

pp. 43-48

Author(s):

Philipp Dahm

Keyword(s):

Prostate Cancer ◽

Randomized Controlled Trial ◽

Radiation Therapy ◽

Controlled Trial ◽

Specific Antigen ◽

Active Monitoring ◽

Risk Of Death ◽

Psa Screening ◽

Psa Testing

This chapter provides a summary of the landmark Prostate Testing for Cancer and Treatment (ProtecT) trial, a three-armed randomized controlled trial of men with clinically localized prostate cancer mostly diagnosed through prostate-specific antigen (PSA) screening comparing radical prostatectomy to radiation therapy or active monitoring. Active monitoring consisted mostly of regular PSA testing. After 10 years of follow-up, very few deaths from prostate cancer occurred, underscoring the very low risk of death from prostate cancer in patients diagnosed by PSA screening irrespective of treatment approach.

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Racial variation in the reliability of prostate cancer indicators in men undergoing subsequent prostate biopsy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.115 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 115-115

Author(s):

Robert Scott Libby ◽

Hoang MT Nguyen ◽

Jordan J. Kramer ◽

Allison H. Feibus ◽

Raju Thomas ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Biopsy ◽

Health Care Services ◽

African American Men ◽

Medical Center ◽

Specific Antigen ◽

Transrectal Ultrasound ◽

Veterans Health ◽

Psa Testing ◽

Incidence And Mortality

115 Background: Many men with an initial negative prostate biopsy have a persistently elevated prostate specific antigen (PSA) prompting physicians to perform repeat biopsies. African American men (AA) are at particular risk as they have a greater prostate cancer (PCa) incidence and mortality, yet traditional PSA testing may be less reliable in this cohort. We sought to determine the predictors of PCa and PCa severity in a racially diverse population on subsequent biopsy following an initial benign biopsy. Methods: Upon receiving Institutional Review Board approval, a retrospective analysis was performed on men with repeat prostate biopsies at Tulane Medical Center and Southeast Louisiana Veterans Health Care Services in New Orleans, Louisiana from 2003-2015. Inclusion criteria included patients with a benign initial prostate biopsy and underwent subsequent repeat prostate biopsy within 5 years. Race, age, serum PSA, PSA density (PSAD), and prostate volume by transrectal ultrasound (TRUS) were evaluated to determine if they correlate with the presence and severity of PCa. Aggressive PCa was defined as Gleason score >6. Results: A total of 209 men were included; 127 (61%) were AA, and 82 (39%) were Caucasian American men (CA). The two groups were similar with respect to PSA, PSAD, and TRUS. More AA (25.2% vs. 17.1%) had a repeat biopsy showing any PCa. Of those with PCa, 28.1% of AA and 28.6% of CA had aggressive PCa. PSAD positively correlated with any PCa (p=.015). TRUS negatively correlated with any PCa (p=.008). PSA levels (p<.001) and PSAD (p<.001) positively correlated with aggressive PCa in CA but not in AA. Conclusions: The goal of prostate biopsy particularly for those with a prior negative biopsy is to detect aggressive PCa. PSA and PSAD positively correlated with finding any PCa in both AA and CA but not with aggressive PCa in AA. PSA and PSAD are less accurate predictors of aggressive PCa in AA, and novel biomarkers are needed. [Table: see text]

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