Incidence and mortality

In Table 1 absolute numbers and age-standardized rates of incidence and mortality are presented for selected regions and countries [1]. In 2008 it was estimated that nearly every seventh case of male malignoma was prostate cancer (899 thousand new cases, 13.6% of the total). Therefore, in men prostate cancer was the second most diagnosed cancer after lung cancer. Approximately three quarters of these cases were diagnosed in more developed countries. The highest incidence rates were measured in Australia, New Zealand, Northern and Western Europe and Northern America. Moderate incidence rates were found in South

America and Eastern Europe. The lowest incidence rates were reported from South-Central Asia.

Region

Incidence absolute

Incidence ASR (W)

Mortality absolute

Mortality ASR (W)

World

899

27.9

258

7.4

More developed regions

644

61.7

136

10.5

Less developed regions

255

11.9

121

5.6

Asia

133.2

7.2

59.6

3.2

North America

213.7

85.7

32.6

9.9

Central America

20.5

34.8

8.1

12.6

South America

84.1

50.2

29.2

16.2

Australia and New Zealand

21.0

104.2

4.0

15.4

Central and Eastern Europe

58.4

29.1

23.1

10.9

Northern Europe

64.9

73.1

17.4

15.4

Southern Europe

79.5

50.0

20.4

10.4

Western Europe

167.9

93.1

28.7

12.4

Germany

70.8

82.7

12.2

11.7

Japan

38.7

22.7

10.0

5.0

USA

186.3

83.8

28.6

9.7

Brazil

41.6

50.3

14.4

16.3

China

33.8

4.3

14.3

1.8

India

14.6

3.7

10.4

2.5

Russian Federation

22.1

26.1

9.5

10.8

SouthAfricanRepublic

7.5

59.7

2.5

20.8

Absolute numbers in thousands; ASR (W): age standardised rate per 100,000 by world standard

Table 1. Absolute numbers and age-standardised rates of incidence and mortality for selected regions and countries [1]

Table 1. Absolute numbers and age-standardised rates of incidence and mortality for selected regions and countries [1]

Despite its high proportion of cancer diagnoses, prostate cancer is the cause of cancer specific death in only every 16th case (258 thousand deaths, 6.1% of the total). This places prostate cancer on the sixth position of cancer-specific causes of death, topped by lung, liver, stomach, colorectal and oesophageal cancer. These deaths occur almost equally in both, more developed and less developed regions, thus leading to a twofold higher mortality rate in the more developed regions.

2.1. Incidence and mortality trends

Table 2 shows the current incidence and mortality of the USA [2], Germany [7, 8] and the Munich Cancer Registry [4]. These rates have changed considerably over time. Time series of more developed countries show that the incidence rates experience a drastic rise from 1985 to 1995 and remain at this high level. In the USA incidence (by world standard per 100,000) increases slowly from 1975 until 1985 (from 50 to 65). Then it rises rapidly reaching a peak of 135 in 1992. Then it decreased, since 1995 more slowly, but it remains on a higher level than before the peak (around 110). In Germany incidence is rising continuously since 1988 (from 30 to 75). The main explanation for these trends is the broad use of prostate specific antigen (PSA) testing as a screening method and performing biopsies, which started in the mid-1980s in the USA and in the early 1990s in Germany.

Table 2 shows the current incidence and mortality of the USA [2], Germany [7, 8] and the Munich Cancer Registry [4]. These rates have changed considerably over time. Time series of more developed countries show that the incidence rates experience a drastic rise from 1985 to 1995 and remain at this high level. In the USA incidence (by world standard per 100,000) increases slowly from 1975 until 1985 (from 50 to 65). Then it rises rapidly reaching a peak of 135 in 1992. Then it decreased, since 1995 more slowly, but it remains on a higher level than before the peak (around 110). In Germany incidence is rising continuously since 1988 (from 30 to 75). The main explanation for these trends is the broad use of prostate specific antigen (PSA) testing as a screening method and performing biopsies, which started in the mid-1980s in the USA and in the early 1990s in Germany.

(SEER, NCHS)

Germany (RKI)

MCR [4]

[2, 6]

[7, 8]

Absolute incidence

241.7

70.8

2.9

Crude incidence

157.7

145.1

Incidence ASR (W)

106.1

82.7

76.4

Mortality ASR (W)

10.2

11.7

13.3*

Lifetime risk(%)

16.2

13.0

Median age at diagnosis(years)

67.0

69.5

67.2

Median age at death(years)

80.0

76.7

5-year overall survival(%)

77.0

79.2

5-year relative survival(%)

99.2

92.0

93.4

10-year overall survival(%)

58.2

10-year relative survival(%)

98.3

87.8

Absolute numbers in thousands

ASR (W): age standardised rate per 100,000 by world standard

Incidence and mortality from cohorts of 2008 (all regions)

Absolute incidence numbers of the USA are estimates of SEER data from 2012

* Mortality ASR (W) for singular prostate cancers is 9.9

median ages from cohorts of 2005-2009 (all regions)

5-year survival from cohorts of 2002-2008 (SEER and MCR)

10-year survival from cohorts of 1998-2008 (SEER and MCR)

Table 2. Epidemiologic basic numbers

In the USA, mortality initially increases slightly from 1975 and since 1992 it is decreasing more rapidly (from 14 over 17 to 10). In Germany the mortality rate (by world standard per 100,000) stays stable at 13.

2.2. Age distribution and age-specific incidence and mortality rate

Nearly all patients (« 99%) who are diagnosed with prostate cancer have reached an age of fifty or higher. The age distribution at diagnosis describes a positively skewed unimodal distribution with its modus at the age group 65-69. This age group contributes to nearly 25% of all prostate cancer cases. The risk of getting prostate cancer increases nearly exponentially with increasing age. This makes prostate cancer one of the most distinctive cancers in aging populations (Figure 1) with a ASIR of 800-1000 per 100,000 in the elderly of 70 years and older.

/

/

/

\

ll

J

age at diagnosis (years) age distribution ASIR

CM CM CO CO

in in to to age at diagnosis (years) age distribution ASIR

Figure 1. Age distribution at diagnosis and age-specific incidence rate (ASIR) of prostate cancer (1998-2008) [4]

Nearly all patients who died of prostate cancer (singular initial malignoma) have reached an age of fifty-five or higher. The distribution of age at death describes a negatively skewed unimodal distribution with its modus at the highest age group 85+. Here the age-specific mortality rates (ASMR) can perfectly be described by an exponential function. The risk of dying by prostate cancer increases accelerated with increasing age (Figure 2). The ASMR reaches 450 per 100,000 for men with an age of 80-84 and already 600 per 100,000 for men older than 84.

LO m CO Ö LÖ ö m m cd age at death (years) age distribution ^-ASMR

Figure 2. Age distribution at death and age-specific mortality rate (ASMR) of prostate cancer (1998-2009) [4]

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