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Prostate cancer incidence, mortality declines or stabilizes in most countries
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ATLANTA — Rates of prostate cancer incidence and mortality are decreasing or remaining steady in most parts of the world, according to study results presented at American Association for Cancer Research Annual Meeting.
In 2012, prostate cancer was the most prevalent cancer among men in 96 countries and the leading cause of death in 51 countries. It remains the second most commonly diagnosed cancer and the sixth leading cause of cancer death among men worldwide, according to study author MaryBeth Freeman, MPH, senior associate scientist of surveillance research at the American Cancer Society.
“Previous studies have indicated significant variation in prostate cancer rates, due to factors including detection practices, availability of treatment and genetic factors,” Freeman said in a press release. “By comparing rates from different countries, we can assess differences in detection practices and improvements in treatment.”
In the study, Freeman and colleagues estimated age-standardized incidence of prostate cancer and mortality rates by country and WHO regions for 2012 based on GLOBOCAN data. They assessed long-term trends (1980 through 2012) in incidence and mortality for 38 countries with high-quality, population-based data.
Additionally, they assessed short-term trends in prostate cancer during the most recent 5 years (most often 2008 through 2012) among 44 countries with accessible incidence data and 71 countries with available mortality information.
Results of the short-term trend analysis showed Brazil, Lithuania and Australia had the highest incidence rates of prostate cancer, whereas India, Thailand and Bahrain had the lowest rates. Prostate cancer mortality rates during the most recent 5 years were highest in the Caribbean (Barbados, Trinidad and Tobago, and Cuba), South Africa, Lithuania, Estonia and Latvia, and lowest in Thailand and Turkmenistan.
Four of the 44 countries with accessible, high-quality incidence data demonstrated increases in prostate cancer incidence over the most recent 5 years, with Bulgaria showing the most significant increase. Incidence decreased in seven countries, with the largest reduction in the United States, and stabilized in the remaining 31 countries.
Conversely, during the same period, prostate cancer mortality rates among the 71 countries evaluated for this trend decreased in 14 countries, increased in three countries and stabilized in 54 countries.
The researchers noted that their study is limited by the variability in data collection among the countries.
According to Freeman, the study results highlight the importance of PSA screening, increasing use of which coincided with the decline in prostate cancer between the mid-2000s and 2015. She said some countries plan to reduce their recommendations for PSA screening based on the belief that it leads to overtreatment of prostate cancer.
“Overall, patients should be having an informed discussion with their providers about the benefits and harms of PSA testing for detection of prostate cancer,” Freeman said in the press release. “Future studies should monitor trends in mortality rates and late-stage disease to assess the impact of reduction in PSA testing in several countries.”– by Jennifer Byrne
Reference:
Freeman MB, et al. Abstract LB171. Presented at: AACR Annual Meeting; March 29-April 3, 2019; Atlanta.
Disclosures: The study was funded by the American Cancer Society. Freeman reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.
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John D. Carpten, PhD
Undoubtedly, prostate cancer incidence and mortality rates have gone down. We have seen those rates, but we still have not nailed down why.
One reason, of course, could be PSA testing. During this time period, we had robust standard testing and screening, so we were able to detect a lot of cancers and cure those men through relatively invasive procedures like radical prostatectomy, but side effects come along with that.
The field has always struggled with whether PSA screening was really leading to reduction in mortality rates. I think the numbers are pretty solid now.
There must be a balance. One of the big problems is that PSA is a great biomarker to say there is something wrong with the prostate, but not necessarily that there is cancer. This study tells me that we need better biomarkers. If we had a biomarker that was more specific to prostate cancer, but with a high degree of sensitivity, we could do even better. We would see even greater declines, because we would know there is cancer there. Alongside that, if we had biomarkers that could be more prognostic — to say not only is there cancer, but cancer that is high grade or low grade — we could do a better job of managing the treatment. We could still see a decline in mortality rates, but at the same time, not overtreat.
The whole issue of PSA and declines in mortality and overtreatment is all related to the problems with PSA as a biomarker. What we need are better biomarkers.
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