Tracking and analysis of benign prostatic hyperplasia and prostate cancer burden globally: 1990-2021 epidemiological trends

Abstract

Background: Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are prevalent prostate conditions in middle-aged and elderly men, yet comprehensive and current epidemiological data remain scarce. This study aimed to comprehensively evaluate the global burdens of BPH and PCa from 1990 to 2021.

Methods: We analyzed data on BPH and PCa from the Global Burden of Disease 2021 database, including incidence, disability-adjusted life-years (DALYs), mortality, and attributable risk factors. Estimated annual percentage changes (EAPC) were calculated to assess trends in age-standardized incidence rates (ASIR), age-standardized DALY rates (ASDR), and age-standardized mortality rates (ASMR). We also examined correlations between the burden of these conditions and socio-demographic indices (SDI).

Results: From 1990 to 2021, the incidence of BPH and PCa increased by 115.23% and 161.66%, respectively. Over the 32-year period, PCa showed a decreasing trend in ASMR and ASDR (EAPC =-0.68 and -0.83, respectively), with no significant change in ASIR. BPH burdens were highest in Eastern Europe and Asia, while PCa burdens were concentrated in high-income North America and Australasia. The highest incidence rates for BPH were in the 65-69 age group, and for PCa in those aged 85 years and older. Smoking-related DALYs and mortality among PCa patients decreased annually across all age groups throughout the study period.

Conclusions: BPH and PCa continue to pose significant global health challenges due to their increasing absolute burden. Although the relative burden of BPH remains stable and PCa shows a declining trend, strategic resource allocation based on regional epidemiological features and geographical distributions is crucial.

Keywords: Benign prostatic hyperplasia (BPH); Global Burden of Disease; disability-adjusted life-years (DALYs); incidence; prostate cancer (PCa).

Figure 1

The global trends of the ASIR (A), ASDR (B), and ASMR (C) of BPH and PCa from 1990 to 2021. ASIR, age-standardized incidence rate; ASDR, age-standardized DALYs rate; ASMR, age-standardized mortality rate; DALYs, disability-adjusted life-years.

Figure 2

Age-stratified global trends: BPH and PCa incidence (A,C) and DALYs (B,D) rates in 1990 and 2021. The global incidence (A) and DALYs (B) rates of BPH and PCa by age in 1990; the global incidence (C) and DALYs (D) rates of BPH and PCa by age in 2021. BPH, benign prostatic hyperplasia; DALYs, disability-adjusted life-years; PCa, prostate cancer.

Figure 3

The comparison of global ASIR (2021), incidence relative changes and EAPC for ASIR (1990–2021) of BPH and PCa. The global ASIR of BPH (A) and PCa (D) in 2021; the relative change in incident cases of BPH (B) and PCa (E) between 1990 and 2021; the EAPC of ASIR for BPH (C) and PCa (F) from 1990 to 2021. The countries and territories exhibiting an extreme number of cases or evolution were annotated. ASIR, age-standardized incidence rate; BPH, benign prostatic hyperplasia; EAPC, estimated annual percentage change; PCa, prostate cancer.

Figure 4

SDI-stratified ASIR, ASDR, and ASMR of BPH and PCa: global trends (1990–2021) and 2021 comparisons. The ASIR for BPH (A) and PCa (B) for 21 geographic regions by SDI from 1990 to 2021; the ASIR for BPH (C) and PCa (E) for 21 geographic regions by SDI in 2021; the ASDR for BPH (D) and PCa (F) for 21 geographic regions by SDI in 2021; the ASMR for PCa (G) for 21 geographic regions by SDI in 2021. ASIR, age-standardized incidence rate; ASDR, age-standardized DALYs rate; ASMR, age-standardized mortality rate; BPH, benign prostatic hyperplasia; DALYs, disability-adjusted life-years; PCa, prostate cancer; SDI, sociodemographic index.

Figure 5

Correlations between EAPC and ASIR (1990), EAPC and HDI (2021), and ASDR and HDI (2021) for BPH and PCa. The correlation between the EAPC-ASIR and ASIR for BPH and PCa in 1990 (A); the EAPC-ASIR, EAPC-ASDR and HDI for BPH in 2021 (B); the EAPC-ASIR, EAPC-ASDR and HDI for PCa in 2021 (C). The size of circles indicates the number of incidence cases or DALYs for each country or territory in 2021. ASIR, age-standardized incidence rate; ASDR, age-standardized DALYs rate; BPH, benign prostatic hyperplasia; DALYs, disability-adjusted life-years; EAPC, estimated annual percentage change; HDI, human development index; PCa, prostate cancer.

Figure 6

Smoking-attributed PCa burden: annual percent change for ASDR/ASMR trends (1990–2021), age-stratified DALYs/mortality rates (1990, 2021), and regional percentage changes. The temporal trends in global ASDR (A) and ASMR (B) for PCa attributable to smoking from 1990 to 2021; the DALYs (C) and deaths (D) rates due to PCa attributable to smoking by age in 1990; the DALYs (E) and deaths (F) rates due to PCa attributable to smoking by age in 2021; the percentage change of ASDR (G) and ASMR (H) due to PCa attributable to smoking for 21 geographic regions from 1990 to 2021. APC, annual percent change; ASDR, age-standardized DALYs rate; ASMR, age-standardized mortality rate; DALYs, disability-adjusted life-years; PCa, prostate cancer.