Recent incidence and surgery trends for prostate cancer: Towards an attenuation of overdiagnosis and overtreatment?
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
20
06
2018
accepted:
22
12
2018
entrez:
5
2
2019
pubmed:
5
2
2019
medline:
30
10
2019
Statut:
epublish
Résumé
Screening 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. We 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. The 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). The 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.
Sections du résumé
BACKGROUND
Screening 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.
METHODS
We 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.
RESULTS
The 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).
CONCLUSIONS
The 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.
Identifiants
pubmed: 30716740
doi: 10.1371/journal.pone.0210434
pii: PONE-D-18-18293
pmc: PMC6361620
doi:
Types de publication
Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0210434Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
World J Urol. 1997;15(6):331-5
pubmed: 9436281
Urol Int. 2009;83(2):134-40
pubmed: 19752605
J Natl Cancer Inst. 2003 Jun 18;95(12):868-78
pubmed: 12813170
J Natl Cancer Inst. 2013 Oct 16;105(20):1534-9
pubmed: 24092918
Eur J Cancer Prev. 2005 Aug;14(4):309-27
pubmed: 16030421
PLoS Med. 2014 Jul 01;11(7):e1001655
pubmed: 24983872
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
Cancer. 2018 Jul 1;124(13):2801-2814
pubmed: 29786851
CMAJ Open. 2016 Mar 02;4(1):E73-9
pubmed: 27280117
Public Health Rev. 2015 Nov 5;36:8
pubmed: 29450036
JAMA. 2018 Mar 6;319(9):883-895
pubmed: 29509864
Ann Epidemiol. 2018 May;28(5):328-330
pubmed: 29678312
Eur Urol. 2005 Feb;47(2):196-201
pubmed: 15661414
J Natl Cancer Inst. 2010 May 5;102(9):605-13
pubmed: 20413742
Eur Urol. 2012 Jun;61(6):1093-5
pubmed: 22464308
Eur Urol. 2014 Jun;65(6):1046-55
pubmed: 24439788
J Natl Cancer Inst. 2012 Jan 18;104(2):125-32
pubmed: 22228146
PLoS One. 2017 Jun 14;12(6):e0179387
pubmed: 28614405
Public Health Res Pract. 2015 Sep 30;25(4):e2541540
pubmed: 26536502
Ann Intern Med. 2013 Jun 4;158(11):831-8
pubmed: 23732716
Cancer Causes Control. 2018 Feb;29(2):269-277
pubmed: 29204913
BJU Int. 2017 Apr;119(4):560-566
pubmed: 27222299
Am J Epidemiol. 1999 Oct 15;150(8):848-60
pubmed: 10522656
Eur J Cancer Prev. 2017 Sep;26 Joining forces for better cancer registration in Europe:S139-S146
pubmed: 28574868
N Engl J Med. 2012 Mar 15;366(11):981-90
pubmed: 22417251
Scand J Urol Nephrol. 2005;39(2):117-23
pubmed: 16019764
J Natl Cancer Inst. 2005 Sep 7;97(17):1248-53
pubmed: 16145045
Eff Clin Pract. 1999 Sep-Oct;2(5):228-33
pubmed: 10623055
JAMA. 2018 May 8;319(18):1901-1913
pubmed: 29801017
Ann Intern Med. 2012 Jul 17;157(2):120-34
pubmed: 22801674
N Engl J Med. 2011 Nov 24;365(21):1949-51
pubmed: 22029759