Prostate cancer incidence and mortality trends among elderly and adult Europeans

Prostate cancer is a common malignancy primarily of elderly men, with incid ence rates rapidly increasing, owing to the population ageing and the intro duction of more sensitive diagnostic procedures. Although the effectiveness of a screening test remains controversial, the decreasing mortality rates, which recently emerged in the USA, may be partly attributable to the chang es of patterns of care, thus suggesting a potential effect of preventive me asure. The object of this study is to examine time trends in incidence and mortality from prostate cancer in European Union (EU) countries, with parti cular attention to possible differences between the elderly (65 years old o r over) and younger or middle age adults (35-64 years old). EUROCIM, the da ta base created by the European Network of Cancer Registries, provided the incidence and mortality data for the 12 EU Countries analysed (namely: Finl and, Denmark, Scotland, England and Wales, Ireland and The Netherlands in N orthern Europe; Austria, Germany and France in Central Europe; Italy, Spain and Portugal in Southern Europe), for the 1978-1994 period. Incidence and mortality time trends, expressed as mean difference per cent (MD%) per year ,were estimated by a Poisson log-linear regression model. Higher resolution analyses were also carried out to check differences in time trends by age class within the two groups under study. Upward mortality trends occurred i n several countries, excepting Ireland, Austria and Southern Europe, but on ly for younger and middle aged adults. Rates increased more rapidly in olde r age groups; a clear north-south gradient appeared both in the elderly and in younger adults; for the elderly, MD% higher than + 1.5 for most countri es of Northern Europe, MD% around +1 for Central Europe, and MD% less than +1 for Southern Europe were registered, with lower values for younger peopl e. Incidence rates rose across the period considered, almost in all countri es both for elderly and for younger and middle age adults, increasing more rapidly in younger age. Incidence trends showed a less clear geographic pat tern than for mortality. In the younger group, high MD%, ranging in Norther n Europe from + 3.2 in Finland and England and Wales to + 5.7 in The Nether lands. were observed, while in the South values ranged between + 4.2 and 5.0. In Central Europe, very high MD%, ranging between + 8.4 in France and + 16.6 in Austria, were noted. No significant trends were observed for Denm ark, Ireland and Portugal. For the elderly the increase was generally lower and no significant trend was observed in Germany and Portugal. Interaction between age and calendar period in the older group was observed for most o f the considered countries. With reference to mortality, the MD% showed a t endency to rise, with increasing age, while no consistent pattern emerged f or incidence. The observed incidence trends are probably a consequence of t he different times in which the more recent detection methods were introduc ed in each country, and of the different policies adopted by each health ca re system towards the elderly. A comparison with the USA data suggests that in the next future a favourable downward mortality trend could be expected also in some EU Countries and, particularly, for younger age groups, even though prostatic cancer in old patients will remain a great burden, which N ational Health Care Systems will have to face in the next decades. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.