Download Cancer of the prostate - National Cancer Registry Ireland

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