Analysis of recent trends in prostate cancer incidence and mortality

BACKGROUND. There is debate over whether the recent increases seen in prost ate cancer are due to lead-time bias from screening, or identification of c linically insignificant lesions. METHODS. Population-based incidence rates for 1973-1996 were calculated, ba sed on the Surveillance, Epidemiology, and End Results Program (SEER) tumor registries. Relative incidence rates for prostate cancer by stage, fatal i ncidence, and lymph nodes were calculated, adjusted for age. RESULTS. Localized and regional stage prostate cancer increased through 199 2 and then dropped. The rate of distant-stage disease was relatively stable from 1973-1991, with a decrease in distant stage starting in 1992. The 2-y ear mortality rates were constant for 1973-1989. A decline in the 2-year mo rtality among cases (fatal incidence) also began in 1992. CONCLUSIONS. These data show large increases in early disease, followed by a drop and leveling off along with a decrease in advanced disease (distant stage, 2-year mortality, positive lymph nodes). This indicates that the inc reasing incidence rates for prostate cancer are largely due to lead-time bi as from increased early detection and treatment of prostate cancer. However , since incidence rates have not declined to rates seen in the 1970s, the a dditional cases may also reflect length bias from insignificant lesions or a true increase in incidence over time. Prostate 42:247-252, 2000. (C) 2000 Wiley-Liss, Inc.