Prostate cancer incidence and mortality in Europe and implications for screening activities: population based study

Abstract

Objective: To provide a baseline comparative assessment of the main epidemiological features of prostate cancer in European populations as background for the proposed EU screening initiatives.

Design: Population based study.

Setting: 26 European countries, 19 in the EU, 1980-2017. National or subnational incidence data were extracted from population based cancer registries from the International Agency for Research on Cancer's Global Cancer Observatory, and mortality data from the World Health Organization.

Population: Men aged 35-84 years from 26 eligible countries.

Results: Over the past decades, incidence rates for prostate cancer varied markedly in both magnitude and rate of change, in parallel with temporal variations in prostate specific antigen testing. The variation in incidence across countries was largest around the mid-2000s, with rates spanning from 46 (Ukraine) to 336 (France) per 100 000 men. Thereafter, incidence started to decline in several countries, but with the latest rates nevertheless remaining raised and increasing again in the most recent quinquennium in several countries. Mortality rates during 1980-2020 were much lower and less variable than incidence rates, with steady declines in most countries and lesser temporal differences between countries. Overall, the up to 20-fold variation in prostate cancer incidence contrasts with a corresponding fivefold variation in mortality. Also, the inverse U-shape of the age specific curves for incidence contrasted with the mortality pattern, which increased progressively with age. The difference between the highest and lowest incidence rates across countries ranged from 89.6 per 100 000 men in 1985 to 385.8 per 100 000 men in 2007, while mortality rates across countries ranged from 23.7 per 100 000 men in 1983 to 35.6 per 100 000 men in 2006.

Conclusions: The epidemiological features of prostate cancer presented here are indicative of overdiagnosis varying over time and across populations. Although the results are ecological in nature and must be interpreted with caution, they do support previous recommendations that any future implementation of prostate cancer screening must be carefully designed with an emphasis on minimising the harms of overdiagnosis.

Fig 1

Time trends of age standardised incidence and mortality rates for prostate cancer per 100 000 men aged 35-84 years on an arithmetic scale in northern Europe

Fig 2

Time trends of age standardised incidence and mortality rates for prostate cancer per 100 000 men aged 35-84 years on an arithmetic scale in central and southern Europe

Fig 3

Time trends of age standardised incidence and mortality rates for prostate cancer per 100 000 men aged 35-84 years on an arithmetic scale in the Baltic countries and eastern Europe

Fig 4

Range of age standardised incidence and mortality rates of prostate cancer per 100 000 men aged 35-84 years over time among the included European countries. Lines are smoothed by the Loess regression algorithm (bandwidth: 0.4)

Fig 5

Standardised rate ratios between incidence and mortality for prostate cancer across different periods among men aged 35-84 years

Fig 6

Age specific incidence and mortality rates of prostate cancer per 100 000 men during 1998-2002, 2003-07, 2008-12, and 2013-17 in northern Europe

Fig 7

Age specific incidence and mortality rates of prostate cancer per 100 000 men during 1998-2002, 2003-07, 2008-12, and 2013-17 in central and southern Europe

Fig 8

Age specific incidence and mortality rates of prostate cancer per 100 000 men during 1998-2002, 2003-07, 2008-12, and 2013-17 in the Baltic countries and eastern Europe