Recent incidence and surgery trends for prostate cancer: Towards an attenuation of overdiagnosis and overtreatment?

Abstract

BackgroundScreening for prostate cancer is frequent in high-income countries, including Switzerland. Notably due to overdiagnosis and overtreatment, various organisations have recently recommended against routine screening, potentially having an impact on incidence, mortality, and surgery rates. Our aim was therefore to examine whether secular trends in the incidence and mortality of prostate cancer, and in prostatectomy rates, have recently changed in Switzerland.MethodsWe conducted a population-based trend study in Switzerland from 1998 to 2012. Cases of invasive prostate cancer, deaths from prostate cancer, and prostatectomies were analysed. We calculated changes in age-standardised prostate cancer incidence rates, stratified by tumor stage (early, advanced), prostate cancer-specific mortality, and prostatectomy rates.ResultsThe age-standardised incidence rate of prostate cancer increased greatly in men aged 50–69 years (absolute mean annual change +4.6/100,000, 95% CI: +2.9 to +6.2) between 1998 and 2002, and stabilised afterwards. In men aged ≥ 70 years, the incidence decreased slightly between 1998 and 2002, and more substantially since 2003. The incidence of early tumor stages increased between 1998 and 2002 only in men aged 50–69 years, and then stabilised, while the incidence of advanced stages remained stable across both age strata. The rate of prostatectomy increased markedly until 2002, more so in the 50 to 69 age range than among men aged ≥ 70 years; it leveled off after 2002 in both age strata. Trends in surgery were driven by radical prostatectomy. Since 1998, the annual age-standardised mortality rate of prostate cancer slightly declined in men aged 50–69 years (absolute mean annual change -0.1/100,000, 95% CI: -0.2 to -0.1) and ≥ 70 years (absolute mean annual change -0.5/100,000, 95% CI: -0.7 to -0.3).ConclusionsThe increases in the incidence of early stage prostate cancer and prostatectomy observed in Switzerland among men younger than 70 years have concomitantly leveled off around 2002/2003. Given the decreasing mortality, these trends may reflect recent changes in screening and clinical workup practices, with a possible attenuation of overdiagnosis and overtreatment.

The relative risk of second primary cancers in Switzerland: a population-based retrospective cohort study

“…Overall, more than 50% of patients with first prostate cancer are treated with surgery including radical prostatectomy [41]. In Switzerland, prostate cancer incidence rates have recently decreased after a sustained increase up to 2002, most likely due to changes in screening and work-up practices [42]. Higher socioeconomic position (SEP) has been shown to be associated with more frequent prostate-specific antigen (PSA) screening, earlier diagnosis [28,43] and higher prostate cancer incidence compared to men with lower SEP. [44,45] In addition, men of higher SEP are generally more health conscious than the general male population [46] and thus less likely to O: number of observed cases E: number of expected cases SIR: standardized incidence ratio 95%CI: 95% confidence intervals be exposed to cancer risk such as cigarette smoking and alcohol consumption.…”

Pathological upgrading in prostate cancer treated with surgery in the United Kingdom: trends and risk factors from the British Association of Urological Surgeons Radical Prostatectomy Registry

“…Furthermore, neither involved participants from the United Kingdom (UK), thereby limiting the generalisability of findings to this patient population and the National Health Service. This is of particular importance as, owing to differences in screening practices across Europe and North America, a relatively high proportion of patients present with advanced disease at the time of diagnoses in the UK [14–18].…”

Promoting cell proliferation, cell cycle progression, and glycolysis: Glycometabolism‐related genes act as prognostic signatures for prostate cancer

“…Risk stratification is critical for PCa patients, both following a new diagnosis and after radical treatment. Although AS application is expanding, the overtreatment of PCa remains a concern in these patients 23,24 . In addition, it was reported that approximately 24%–34% of men with BCR are expected to progress to clinically evident recurrence within 15 years after RP.…”

“…Patients with the same histological and clinical parameters might show significantly different molecular characteristics and have different clinical predictions 27 . Although the risk stratification of PCa, developed by D'Amico, 28 has been adopted by the National Comprehensive Cancer Network and is widely used in related treatment decision‐making, overdiagnosis and over or undertreatment remain important concerns among PCa patients 24,29 . Thus, uncovering more powerful methods to identify PCa patients who are at a higher risk of progression seems crucial.…”