Prostate cancer in Denmark 1978–2009 — trends in incidence and mortality

Abstract

Background. The incidence of prostate cancer (PC) has increased during the last 15 years in Denmark, whereas the mortality has remained largely unchanged. This register study aimed to investigate the trends in PC incidence and mortality in Denmark 1978Denmark -2009 (1978 -2007) and a two-year calendar period (2008 -2009). Trends in incidence rates were estimated for specifi c age groups, birth cohorts, and clinical stage. Results. The age-standardised incidence rate of PC increased from 29.2 per 100 000 person-years in 1978 -1982 to 76.2 per 100 000 person-years in 2008 -2009. The incidence increase began primarily in the mid-1990s. The corresponding mortality rates of PC remained largely unchanged during the entire study period; around 19 per 100 000 person-years. The incidence increase was most pronounced among men aged 60 ϩ years. A clear pattern was also seen for selected birth cohorts, with increasing incidence rates among the youngest cohorts, and the highest relative increase in age-specifi c incidence rates was seen among men born between 1943 and 1947. The distribution of stage changed from 1998, with an increasing proportion of PC patients with localised disease. Conclusion. The observed increase in PC incidence during the period 1993 -2009 in Denmark may be attributed primarily to increasing unsystematic use of prostate specifi c antigen (PSA) testing. The mortality rates remained stable during the same period suggesting that there is not yet any major infl uence of intensifi ed PSA screening and more frequent use of curatively intended therapy on the overall prognosis of PC.

Baseline prostate-specific antigen measurements and subsequent prostate cancer risk in the Danish Diet, Cancer and Health cohort

“…Nevertheless, increased non-systematic use of PSA during the past decade has led to a marked rise in the incidence of prostate cancer also in Denmark 26 . A recent study showed that 35% of patients treated by radical prostatectomy in Denmark between 1997 and 2008 had been referred without prostate-related symptoms 27 , and in a Swedish study 28% of prostate cancer cases diagnosed in 2005 were based on PSA testing during health examinations 28 .…”

Length of life gained with surgical treatment of prostate cancer: A population-based analysis

“…PSA screening has been demonstrated to induce a mean lead-time of 6.8 years in PCa diagnosis [11]. Although Denmark has never endorsed regular screening programmes for PCa, a sharp increase in the incidence of PCa and increasing use of PSA among general practitioners are indicative of opportunistic PSA screening in Denmark [12,13]. Therefore, survival in this study is likely to be affected by lead-time bias, i.e.…”

Survival and PSA-markers for mortality and metastasis in nonmetastatic prostate cancer treated with androgen deprivation therapy

“…Prevalence and incidence of PC have increased due to population aging and opportunistic prostate-specific antigen (PSA) testing, resulting in an increase (11-51%) of men with PC being diagnosed with nonmetastatic (M0) PC [3]. Correspondingly, the 5-year PC survival has improved considerably, reaching 60% in Denmark [4].…”