International trends and patterns of prostate cancer incidence and mortality

Prostate cancer is the most commonly diagnosed cancer in western men, and i ncidence is rising rapidly in most countries, including low-risk population s. Age-adjusted incidence and mortality rates from 15 and 13 countries betw een 1973-77 and 1988-92, respectively, were compared to provide leads for f uture analytic studies. Large increases in both incidence and mortality rat es of prostate cancer were seen for all countries. For incidence, increases were more pronounced in the United States, Canada, Australia, France and t he Asian countries, while the increases in medium-risk countries were moder ate. Increases in incidence ranged from 25%-114%, 24%-55% and 15%-104% in h igh-, medium- and low-risk countries, respectively. Mortality rates rose mo re rapidly in Asian countries than in high-risk countries. Substantial diff erences in incidence and mortality across countries were evident, with U.S. blacks having rates that were 50-60 times higher than the rates in Shangha i, China. Increasing incidence rates in the United States and Canada are li kely to be due in part to the widespread use of transurethral resection of the prostate and prostate-specific antigen testing, while increases in the Asian countries are probably related to westernization in these low-risk po pulations. The large disparities in incidence between high- and low-risk co untries may be due to a combination of genetic and environmental factors. F uture studies are needed to examine gene-gene and gene-environment interact ions in various countries concurrently to shed light on the etiology of pro state cancer and to help elucidate reasons for the large differences in ris k between populations. (dagger)Published 2000 Wiley-liss, Inc.