An examination of prostate cancer trends in Australia, England, Canada and USA: Is the Australian death rate too high? — ASN Events
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An examination of prostate cancer trends in Australia, England, Canada and USA: Is the Australian death rate too high? (#427)

Eleonora Feletto 1 , Dane Cole-Clark 2 , Albert Bang 1 , Venu Chalasani 3 4 5 , Kris Rasiah 5 6 , David Smith 1 7
  1. Cancer Research Division, Cancer Council, Sydney, NSW, Australia
  2. Department of Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
  3. Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Sydney, NSW, Australia
  4. Discipline of Surgery, University of Sydney, Sydney, NSW, Australia
  5. Northern Sydney Local Health District, Sydney, NSW, Australia
  6. Garvan Institute of Medical Research & Kinghorn Cancer Centre, Sydney, NSW, Australia
  7. Griffith Health Institute Queensland, Griffith University, Griffith, QLD, Australia

Objectives: To compare prostate cancer incidence and mortality rates in Australia, USA, Canada and England and quantify the gap between observed prostate cancer deaths in Australia and expected deaths, using USA mortality rates.

Subjects/patients (or materials) and methods: Analysis of age standardised prostate cancer incidence and mortality rates, using routinely available data, in four similarly developing countries and joinpoint regression to quantify the changing rates (annual percentage change: APC) and test statistical significance. Expected prostate cancer deaths, using USA mortality rates, were calculated and compared to observed deaths in Australia (1994-2010).

Results: In all four countries, incidence rates initially peaked between 1992 and 1994 but a second, higher peak occurred in Australia in 2009 (188.9/100,000), rising at a rate of 5.8% (1998-2008). Mortality rates in the USA (APC -2.9%; 2004-2010), Canada (APC -2.9%; 2006-2011) and England (APC -2.6%; 2003-2008) decreased at a faster rate compared to Australia (APC: -1.7%; 1997-2011). In 2010, mortality rates were highest in England and Australia (23.8/100,000 in both countries). The mortality gap between Australia and USA grew from 1994 to 2010, with a total of 10,895 excess prostate cancer deaths in Australia compared to USA rates over 17 preceding years.

Conclusion: Prostate cancer incidence rates are likely heavily influenced by Prostate Specific Antigen testing, but the fall in mortality occurred too soon to be solely a result of testing. Greater emphasis should be placed on addressing system-wide differences in the management of prostate cancer to reduce the number of men dying from this disease. 

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