Elsevier

European Urology

Volume 61, Issue 6, June 2012, Pages 1079-1092
European Urology

Platinum Priority – Review – Prostate Cancer
Editorial by Fritz H. Schröder and Monique J. Roobol on pp. 1093–1095 of this issue
International Variation in Prostate Cancer Incidence and Mortality Rates

https://doi.org/10.1016/j.eururo.2012.02.054 Get rights and content

Abstract

Context

Wide variation exists internationally for prostate cancer (PCa) rates due to differences in detection practices, treatment, and lifestyle and genetic factors.

Objective

We present contemporary variations in PCa incidence and mortality patterns across five continents using the most recent data from the International Agency for Research on Cancer.

Evidence acquisition

PCa incidence and mortality estimates for 2008 from GLOBOCAN are presented. We also examine recent trends in PCa incidence rates for 40 countries and mortality rates for 53 countries from 1985 and onward via join-point analyses using an augmented version of Cancer Incidence in Five Continents and the World Health Organization mortality database.

Evidence synthesis

Estimated PCa incidence rates remain most elevated in the highest resource counties worldwide including North America, Oceania, and western and northern Europe. Mortality rates tend to be higher in less developed regions of the world including parts of South America, the Caribbean, and sub-Saharan Africa. Increasing PCa incidence rates during the most recent decade were observed in 32 of the 40 countries examined, whereas trends tended to stabilize in 8 countries. In contrast, PCa mortality rates decreased in 27 of the 53 countries under study, whereas rates increased in 16 and remained stable in 10 countries.

Conclusions

PCa incidence rates increased in nearly all countries considered in this analysis except in a few high-income countries. In contrast, the increase in PCa mortality rates mainly occurred in lower resource settings, with declines largely confined to high-resource countries.

Introduction

Prostate cancer (PCa) is the second most common cause of cancer and the sixth leading cause of cancer death among men worldwide with an estimated 899 000 new cases and 258 000 new deaths in 2008 [1]. The worldwide PCa burden is expected to grow to 1.7 million new cases and 499 000 new deaths by 2030 simply due to the growth and aging of the global population [1]. The only well-established risk factors for PCa are older age, black race/ethnicity, and a family history of the disease [2]. The wide variation in international PCa incidence rates and trends is in part due to the substantial differences worldwide in the diagnosis of latent cancers through prostate-specific antigen (PSA) testing of asymptomatic individuals as well as during prostate surgery. PCa mortality rates and trends are less affected by diagnostic practices but reflect differences in PCa treatment worldwide as well as underlying risk.

We present contemporary variations in PCa incidence and mortality patterns across five continents by examining the most up-to-date incidence rates as published for 40 countries based on 63 population-based cancer registries, as well as mortality rates for 53 selected countries obtained from the World Health Organization (WHO) mortality database. We discuss the time trends in PCa rates in relation to the varying patterns of PCa screening and treatment activities in different countries and their impact on the corresponding incidence and mortality rates worldwide.

Section snippets

Evidence acquisition

PCa incidence and mortality rates for 2008 for all countries worldwide were obtained via the estimates made at the International Agency for Research on Cancer (IARC), as compiled in GLOBOCAN 2008 [1]. The methods used to estimate the incidence and mortality rates for specific countries are described in detail elsewhere and depend on the availability and accuracy of cancer incidence and mortality data for each country [3].

PCa incidence rates and time trends by year were obtained for selected

Geographic variation

Almost 899 000 PCa cases and 258 000 PCa deaths are estimated to have occurred in 2008 worldwide (Table 1), with 72% of the cases and 53% of the deaths in developed countries (all regions of Europe plus North America, Australia/New Zealand, and Japan), representing <20% of the world population. PCa incidence rates varied 24-fold worldwide in 2008 with the highest estimated rates in Australia/New Zealand, western Europe, North America, and the Caribbean and the lowest in south central Asia,

Conclusions

Estimated PCa incidence rates remain highest in the highest income regions of the world including North America, Oceania, and western and northern Europe, whereas mortality rates tend to be highest in low- to middle-income settings including parts of South America, the Caribbean, and sub-Saharan Africa. For the vast majority of countries examined, PCa incidence rates increased over the last 10 yr of observation. Although no examples of declining incidence trends were observed in our study, most

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