Prostate Cancer: Prevalence - Incidence - Mortality

Prostate Cancer has been the most common noncutaneous malignancy in U.S. men since 1984, now accounting for one quarter of all such cancers.

  • Adenocarcinoma of the prostate is the most common cancer in men and the second leading cause of cancer related deaths in men.
  • The detection and treatment of this condition has been revolutionized by the introduction of serum prostate specific antigen [PSA] testing as part of the evaluation for this disease.
  • Refinements in surgical techniques and the application of radiotherapy allow for the treatment of clinically localized disease with decreased morbidity. The choice of therapy is guided by clinical factors and patient preferences, as well as tumor characteristics. Androgen blockade is still the foundation for treating advanced disease. 

Incidence - United States:

  • There will be an estimated 220,000 new cases of prostate cancer this year and 29,200 prostate cancer related deaths. After the abrupt rise in prostate cancer diagnosis with the introduction of PSA and the detection of disease in the prevalence population [cull effect] the yearly incidence is somewhat stable. The death rate has been gradually decreasing over the past several years, yet it is too early to say if this is a direct result of early detection and treatment.  
  • Prostate cancer incidence varies by race/ethnicity, with African-Americans at highest risk.  The years in which peak rates were observed can be differentiated by race: 1992 for whites (237.8 per 100,000 men) and 1993 for African-Americans in (343.1 per 100,000).
  • African-American men have the highest reported incidence of prostate cancer in the world, with a relative incidence of 1.6 compared with white men in the United States.  
  • Although African-Americans have experienced a greater decline in mortality than white men since the early 1990s, their death rates remain more than 2.4 times higher than whites.
  • There are currently no data that clearly indicate a single reason for the observed differences in incidence or mortality, and it seems likely that the source of this difference is multifactorial.
  • For 2008, the American Cancer Society estimated 186,320 new cases of prostate cancer in the United States.

Mortality - United States:

  • Estimated new cases and deaths from prostate cancer in the United States in 2012:

    New cases: 241,740
    Deaths: 28,170

  • In 2008, the American Cancer Society estimated 28,660 prostate cancer–related deaths in the United States, for an approximate annual rate of 23.3 per 100,000 population, representing a 41% decrease from the peak in 1991.
Incidence and Mortality - Worldwide:
  • Incidence rates show that prostate cancer is the fifth most common malignancy worldwide and the second most common in men.
  • Prostate cancer makes up 11.7% of new cancer cases overall, 19% in developed countries, and 5.3% in developing countries. Its incidence varies widely between countries and ethnic populations, with disease rates differing by more than 100-fold.
  • The lowest yearly incidence rates occur in Asia (1.9 cases per 100,000 in China) and the highest in North America and Scandinavia, especially in African-Americans (249 cases per 100,000).  
  • As in the United States, prostate cancer incidence has increased in many countries since the early 1990s, with the largest increases in high-risk countries.  
  • Mortality also varies widely among countries, being highest in the Caribbean (28 per 100,000 per year) and lowest in Southeast Asia, China, and North Africa (<5 per 100,000 per year).  
  • The CONCORD study, a worldwide population-based analysis of cancer survival in five continents, recently analyzed international differences in survival for breast, colorectal, and prostate cancer.  
  • Using data from cancer registries, age-standardized 5-year survival rates were found to vary greatly, ranging from 80% or higher in the United States (92%), Australia, and Canada, to less than 40% in Denmark, Poland, and Algeria.
  • Whether these racial differences in incidence and mortality are due to socioeconomic or biological factors remains controversial. Differences in screening rates between whites and African-Americans may play a role in explaining the differences in mortality, although the 2005 National Health Interview Survey demonstrated that among men ages 40 to 49 years, African-American men were more likely to have had a PSA test than white men, and there were no significant differences in PSA screening rates by race/ethnicity in men ages 50 to 79 years.  
  • Data from autopsy studies have shown, however, a higher incidence of prostate intraepithelial neoplasia in African American men when compared with Caucasian men, suggesting that biological differences in tumorigenesis may exist. 
  • Data from radical prostatectomy specimens demonstrates a higher incidence of tumors in both the peripheral and transition zones of African American men compared with Caucasian men. 
  • Even among those treated with “watchful waiting,” African- American men may receive less intensive follow-up.
  • Thus far, a number of racial differences at the molecular level have been described and include variation in the androgen signaling and steroid biosynthesis pathways. 
  • Studies have consistently shown that African-American men are more likely to receive androgen-deprivation therapy, expectant management or external beam radiation therapy, and are less likely to undergo radical prostatectomy compared with white men.  
  • Autopsy incidence. Incidental prostate cancer is noted in 30% of men in the 6th decade of life and increases significantly through the ninth decade. These data have been reproduced in populations for several areas in the world. 
  • Recent studies also suggest that this significant sub-clinical level of prostate cancer is present in men as early as the fourth decade of life.
References
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