International trends in prostate-cancer mortality in the "PSA ERA"

Incidence and mortality from prostate cancer were rising in most countries until the late 1980s, Following a number of advances in the management of p rostate cancer, including introduction of the prostate-specific antigen (PS A) test, there have been reports of declines in mortality in Canada, the Un ited States and the United Kingdom. To investigate the extent to which this pattern was seen in other industrialised countries, we used routinely coll ected data to explore recent changes in prostate-cancer mortality. Trends i n age-standardised death rates between 1979 and 1997 for men aged 50 to 79 years in 24 industrialised countries were compared using join point regress ion. loin point regression allows estimation of the annual percentage chang e in death rates and tests for significant changes in trend. During the per iod studied, age-standardised mortality increased at 1% to 2% per year in m ost countries. In 7 countries (Canada, United States, Austria, France, Germ any, Italy and United Kingdom). a significant down-turn in age-standardised mortality was observed over the period 1988-1991, Trends in age-specific r ates within these countries support a period effect on prostate-cancer mort ality. Declines in mortality could result from any combination of either ar tefact, reduction in prostate-cancer incidence, a rise in competing causes of death or changes in the risk of death from prostate cancer. There are in consistencies in the relationship between national mortality trends and upt ake of PSA screening; further research is required to determine whether cha nges in death rates can be explained by international and secular variation s in the treatment of prostate cancer. (C) 2001 Wiley-Liss. Inc.