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Cancer Trends. No. 3. Recent trends in prostate cancer. May 2010 Cancer Trends Figure 1. Time trends in prostate cancer incidence 3,000 Cancer of the prostate 150 130 2,500 90 1,500 70 50 1,000 30 10 1% a year, although case numbers are increasing 2009 2008 2007 2006 2005 2004 2003 2002 2001 ‐10 2000 then, the age-standardised rate has increased by only 1999 0 1998 numbers and 9% for age-standardised rate. Since 1997 500 1994 between 1998 and 2004 (Figure 1), by 11% for case 1996 between 1994 and 1998, but then increased sharply 2,000 1995 Prostate cancer incidence increased by 4% annually cases per year 110 Incidence trends age‐standardised incidence rate, per 100000 persons per year (EASR=age-standardised incidence rate, European standard population) year of diagnosis number of cases slightly more rapidly (3%) due to demographic change (population ageing). age‐standardised incidence rate Figure 2. Time trends in prostate cancer, by age at diagnosis Cancer incidence increased in all age groups but the 1200 oldest (85 and over), although the increase in the 75- 1000 84 year age group was small. The largest absolute was in the 55-64 year age group, from 134 cases in 1994 to 859 in 2009 (15% annually), but the largest 800 cases per year change in case numbers between 1994 and 2009 under 54 600 55‐64 65‐74 400 relative increase (19% annually) was in men aged 75‐84 85+ 200 under 55. (Figure 2). 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 Trends in stage 1995 1994 0 year of diagnosis The percentage of diagnosed cases which were T1 Figure 3. Time trends in prostate cancer stage (as clinically assessed) increased from 18% to 35% between 1994 and 2007, and the percentage of T2 1200 cancers increased from 14% to 34% (Figure 3). Most 1000 of the increase in T1 tumours was in T1c cases T4 tumours made up a lower fraction of the cancers in 2007 than in 1994, their numbers increased, from 800 cases per year (diagnosed by PSA test and biopsy). Although T3 and T1 T1c 600 T2 T3 400 47 to 212 for T3 and from 38 to 55 for T4. While T1 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 overall levelling-off in incidence, have decreased, as 0 1995 number since 2004, T2 cancer cases, in line with the Tx 1994 and T1c cancers have continued to increase in T4 200 year of diagnosis have cancers of unknown stage (Tx). Prostate cancer facts at a glance Number of prostate cancer cases 2007 Number of prostate cancer deaths 20061 Age-standardised incidence rate 2007 Age-standardised mortality rate 20061 Risk of developing prostate cancer before age 75 Risk of dying of prostate cancer before age 751 1. 2720 543 142 cases per 100,000 per year 29 deaths per 100,000 per year 1.3% 0.9% Source: Central Statistics Office “Annual Report on Vital Statistics 2006”. More information on cancer is available on our website www.ncri.ie © National Cancer Registry 2010 Cancer Trends. No. 3. Recent trends in prostate cancer. Treatment May 2010 Figure 4. Time trends in prostate cancer treatment 1996-2007 During the period 1996-2007, the percentage of cancer 100% patients having definitive treatment remained close to 90% 80% (Figure 4). The percentage having surgery fell from 70% 60% 50% 40% 30% in 1996 to 46% in 2000 and declined slowly thereafter, 20% 10% to 35% in 2007. Some of this apparent fall may be due patient/community treatment. The latter is less likely to and in stage T1c and T2 cancer, suggests a central role 45000 between 1995 and 2004 (Figure 5). This phenomenon has been reported in most developed countries, although the rate of increase in Ireland was more than twice that in Northern Ireland1, suggesting that health Age standardised rate of PSA testing/100,000 50000 number of PSA tests carried out increased five-fold 2007 2006 2005 2004 2003 surgery radiotherapy hormone therapy all definitive treatment chemotherapy Figure 5. Annual number of PSA tests 1994-2005 The increase in prostate cancer rates in younger men, for PSA testing of asymptomatic men (“screening”). The 2002 year of diagnosis have been completely ascertained by the Registry. Why are prostate cancer incidence rates increasing? 2001 2000 1999 1998 1996 0% to a shift from in-patient/day case treatment to out- 1997 19% to 41% while hormone therapy increased from 36% % of cases treated 57% to 27%, radiotherapy treatments increased from 80% 40000 35000 30000 <50 years >50 years 25000 20000 15000 10000 5000 service factors have had some influence. 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Prostate cancer mortality Figure 6. Prostate cancer mortality, Ireland 1950-2006 The number of deaths and the mortality rate from 35 6) to 1995. The death rate has been decreasing by 600 30 1.4% annually since then, but the number of deaths is 500 in mortality, which preceded the widespread use of PSA, cannot be attributed to PSA "screening". Similar patterns in mortality rates (increases followed by falls) have been seen in many other countries (Figure 7). Further information about PSA testing and prostate cancer in Ireland can be found in: number of deaths not falling, because of ageing of the population. This fall age‐standardised mortality per 100,000 700 prostate cancer have increased from the 1950s (Figure 25 400 20 300 15 200 10 100 5 0 0 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 number of deaths Figure 7. Prostate cancer mortality 1990-2005 Trends in prostate specific antigen testing in Ireland: lessons from a country without guidelines. Drummond FJ, Carsin AE, Sharp L, Comber H. Ir J Med Sci. 2010 mortality rate age‐standardised mortality rate 0 5 10 15 20 25 Australia Austria Canada 179(1):43-9 Denmark Finland and in the reference cited in footnote 1. France Germany Ireland Japan 1 Impact of PSA testing and prostatic biopsy on cancer incidence and Norway Sweden mortality: comparative study between the Republic of Ireland and Switzerland Northern-Ireland. A-E Carsin, F J Drummond, A Black, P.J van Leeuwen, L The Netherlands Sharp, LJ Murray, D Connolly, L Egevad, M Boniol, P Autier, H Comber, A Gavin. Cancer Causes and Control, in press. United Kingdom United States of America More information on cancer is available on our website www.ncri.ie © National Cancer Registry 2010 1990 1995 2000 2005