Aim: We report changes in the apparent incidence of prostate cancer in the PSA era, and its association with prostate cancer mortality. Method: We used cohort analysis of routinely collected prostate cancer incidence and mortality data in Australia. Results: Incidence rose dramatically from about 1987 to 1993, for all age groups >55, but the greatest rise was for those aged >70-years. Thereafter, incidence fell for those > 70, but continued to rise for those aged 45-64 years. The incidence initially rose at all ages. After 2000 it continued to rise, the largest change being 4 per 1000 at about age 65, then the incidence curve is flat thereafter, producing a diagnostic lead time of about 15 years over the pre-test era. Mortality rose from ~1980, particularly among men >75, peaking in ~1994. It has dropped steadily since, for age groups over 65. The 2007 mortality curve is later and 1 per 1000 lower than in earlier years. Discussion: These data are consistent with the introduction of screening producing a epidemic of over-diagnoses of prostate cancer (the apparent substantial rises in incidence); while small changes in mortality are as predicted by an over-diagnosis model. We cannot discount the effects of improved treatment during this time. Since early treatment may have effects up to 20 years later, it is difficult to discern whether screening has produced some effects to balance the harm of over-diagnosing many men as having prostate cancer 15 years earlier than would have presented clinically. Title Prof City Calgary Full Name James A Dickinson Country Canada Affiliation Departments of Family Medicine and Phone 403 210 9213 Community Health Sciences, University of Calgary Institutional G012, Health Sciences Centre Fax 403 476 8766 3330 Hospital Dr NW Address Calgary Alberta
Aim: We report changes in the apparent incidence of prostate cancer in the PSA era, and its association with prostate cancer mortality. Method: We used cohort analysis of routinely collected prostate cancer incidence and mortality data in Australia. Results: Incidence rose dramatically from about 1987 to 1993, for all age groups >55, but the greatest rise was for those aged >70-years. Thereafter, incidence fell for those > 70, but continued to rise for those aged 45-64 years. The incidence initially rose at all ages. After 2000 it continued to rise, the largest change being 4 per 1000 at about age 65, then the incidence curve is flat thereafter, producing a diagnostic lead time of about 15 years over the pre-test era. Mortality rose from ~1980, particularly among men >75, peaking in ~1994. It has dropped steadily since, for age groups over 65. The 2007 mortality curve is later and 1 per 1000 lower than in earlier years. Discussion: These data are consistent with the introduction of screening producing a epidemic of over-diagnoses of prostate cancer (the apparent substantial rises in incidence); while small changes in mortality are as predicted by an over-diagnosis model. We cannot discount the effects of improved treatment during this time. Since early treatment may have effects up to 20 years later, it is difficult to discern whether screening has produced some effects to balance the harm of over-diagnosing many men as having prostate cancer 15 years earlier than would have presented clinically. Title Prof City Calgary Full Name James A Dickinson Country Canada Affiliation Departments of Family Medicine and Community Health Sciences, University of Calgary Phone 403 210 9213 Institutional Address G012, Health Sciences Centre 3330 Hospital Dr NW Calgary Alberta Fax 403 476 8766