Changing trends in prostatic cancer

Objectives To examine the diagnosis and treatment of prostatic cancer in a population-based study, reporting incidence trends and survival, in the dec ade before the introduction of prostate-specific antigen (PSA) testing, and thus determine whether the overall incidence of prostatic cancer is increa sing or not. Patients and methods The study included all men registered as having prosta tic cancer in the Yorkshire region between 1981 and 1990. The Northern and Yorkshire Cancer Registry and Information Service has an active registratio n policy and after notification, the information received is validated by h istopathology reports and case-note review. Of the patients registered, 68% were over 70 years old at the time of diagnosis (mean age 74 years). Prost atic cancer was often diagnosed incidentally, after prostatectomy for presu med benign disease. Indications for treatment were not recorded, but most p atients had treatment which was designed to control outlet bladder symptoms rather than with intent to cure cancer. Results In all, 8118 patients with prostatic cancer were registered, of who m 6587 had histological confirmation, There was a 30% increase in the age-s tandardized incidence of prostatic cancer during the study period (P<0.001) . The mortality from prostatic cancer increased by 35% (P<0.001) and the pe rcentage of patients known to have metastases at the time of presentation i ncreased from 18% to 24%. These changes were seen in all age groups. The ov erall survival was 49% at 5 years and 34% at 10 years. Conclusions There has been a real increase in the incidence of prostatic ca ncer which pre-dates the use of serum PSA testing. The percentage relative survival of patients with prostatic cancer in Yorkshire during the study pe riod is similar to that seen in other parts of the UK, but compares badly w ith reported survival in other countries.