Changes in prostate cancer incidence, mortality and survival in relation to prostate specific antigen testing in New South Wales, Australia

Qingwei Luo; Xue Qin Yu; Clare Kahn; Sam Egger; Manish I Patel; Paul B Grogan; Michael Caruana; Karen Canfell; David P Smith; Dianne L O'Connell

doi:10.1016/j.canep.2022.102159

Changes in prostate cancer incidence, mortality and survival in relation to prostate specific antigen testing in New South Wales, Australia

Cancer Epidemiol. 2022 Jun:78:102159. doi: 10.1016/j.canep.2022.102159. Epub 2022 Apr 19.

Authors

Qingwei Luo¹, Xue Qin Yu², Clare Kahn³, Sam Egger⁴, Manish I Patel⁵, Paul B Grogan⁶, Michael Caruana⁷, Karen Canfell⁸, David P Smith⁹, Dianne L O'Connell¹⁰

Affiliations

¹ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia. Electronic address: qingweil@nswcc.org.au.
² The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia. Electronic address: xueqiny@nswcc.org.au.
³ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia. Electronic address: clarek@nswcc.org.au.
⁴ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia. Electronic address: same@nswcc.org.au.
⁵ Specialty of Surgery, University of Sydney, Sydney, New South Wales, Australia; Department of Urology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia. Electronic address: manish.patel@sydney.edu.au.
⁶ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia. Electronic address: paul.grogan@nswcc.org.au.
⁷ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia. Electronic address: michael.caruana@nswcc.org.au.
⁸ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia. Electronic address: karen.canfell@nswcc.org.au.
⁹ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: dsmith@nswcc.org.au.
¹⁰ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia. Electronic address: dianneoconnell525@gmail.com.

PMID: 35447540
DOI: 10.1016/j.canep.2022.102159

Abstract

Background: To examine changes in prostate cancer incidence and mortality rates, and 5-year relative survival, in relation to changes in the rate of prostate specific antigen (PSA) screening tests and the use of radical prostatectomy (RP) in the Australian population.

Methods: Prostate cancer stage-specific incidence rates, 5-year relative survival and mortality rates were estimated using New South Wales Cancer Registry data. PSA screening test rates and RP/Incidence ratios were estimated from Medicare Benefits Schedule claims data. We used multiple imputation to impute stage for cases with "unknown" stage at diagnosis. Annual percentage changes (APC) in rates were estimated using Joinpoint regression.

Results: Trends in the age-standardized incidence rates for localized disease largely mirrored the trends in PSA screening test rates, with a substantial 'spike' in the rates occurring in 1994, followed by a second 'spike' in 2008, and then a significant decrease from 2008 to 2015 (APC -6.7, 95% CI -8.2, -5.1). Increasing trends in incidence rates were observed for regional stage from the early 2000s, while decreasing or stable trends were observed for distant stage since 1993. The overall RP/Incidence ratio increased from 1998 to 2003 (APC 9.6, 95% CI 3.8, 15.6), then remained relatively stable to 2015. The overall 5-year relative survival for prostate cancer increased from 58.4% (95% CI: 55.0-61.7%) in 1981-1985 to 91.3% (95% CI: 90.5-92.1%) in 2011-2015. Prostate cancer mortality rates decreased from 1990 onwards (1990-2006: APC -1.7, 95% CI -2.1, -1.2; 2006-2017: APC -3.8, 95% CI -4.4, -3.1).

Conclusions: Overall, there was a decrease in the incidence rate of localized prostate cancer after 2008, an increase in survival over time and a decrease in the mortality rate since the 1990s. This seems to indicate that the more conservative use of PSA screening tests in clinical practice since 2008 has not had a negative impact on population-wide prostate cancer outcomes.

Keywords: Incidence; Mortality; Prostate cancer; Prostate specific antigen test; Radical prostatectomy; Survival.

MeSH terms

Aged
Australia / epidemiology
Humans
Incidence
Male
National Health Programs
New South Wales / epidemiology
Prostate-Specific Antigen*
Prostatic Neoplasms* / diagnosis
Prostatic Neoplasms* / epidemiology
Prostatic Neoplasms* / surgery

Substances

Prostate-Specific Antigen