Abstract
BackgroundProstate cancer (PC) primarily affects elderly men. However, the specific features of cases diagnosed at younger ages (<65 years) suggest that they may represent a different clinical subtype. Our aim was to assess this suggestion by contrasting the geographical PC mortality and hospital admissions patterns in Spain for all ages to those in younger men.MethodsThe Spanish National Institute of Statistics supplied data on PC mortality, hospital admission, and population data. We estimated the expected town-specific number of deaths and calculated the standardized mortality ratios. Spatial autoregressive models of Besag-York-Mollié provided smoother municipal estimators of PC mortality risk (all ages; <65 years). We computed the provincial age-standardized rate ratios of PC hospital admissions (all men; <60 years) using Spanish rates as the reference.ResultsA total of 29,566 PC deaths (6% among those <65 years) were registered between 2010–2014, with three high-mortality risk zones: Northwest Spain; Southwest Andalusia & Granada; and a broad band extending from the Pyrenees Mountains to the north of Valencia. In younger men, the spatial patterns shared the high risk of mortality in the Northwest but not the central band. The PC hospital discharge rates confirmed a North-South gradient but also low mortality/high admission rates in Madrid and Barcelona and the opposite in Southwest Andalusia.ConclusionThe consistent high PC mortality/morbidity risk in the Northwest of Spain indicates an area with a real excess of risk. The different spatial pattern in younger men suggests that some factors associated with geographical risk might have differential effects by age. Finally, the regional divergences in mortality and morbidity hint at clinical variability as a source of inequity within Spain.
Highlights
Worldwide, prostate cancer (PC) is the second most common tumor among men, with an estimated 1.1 million new cases in 2012[1]
A total of 29,566 PC deaths (6% among those
The steep increase in incidence in most countries in recent decades[2] is generally attributed to the increased detection of indolent prostate neoplasms[3] a potentially increased exposure to unknown risk factors[4] accompanied by a sustained decrease in mortality[5], which, in Spain started in the late 1990s[6]
Summary
Prostate cancer (PC) is the second most common tumor among men, with an estimated 1.1 million new cases in 2012[1]. With an estimated 307,000 deaths in 2012, PC ranks fifth as the cause of cancer death worldwide among men and third among European and Spanish men[1,7]. None of the main well-established risk factors -age, genetic susceptibility[8], black race, and familial history- are modifiable[4]. The association of this tumor with other factors such as chemical contaminants[9], diet[10], and medications[11], among others, is not yet clear. Our aim was to assess this suggestion by contrasting the geographical PC mortality and hospital admissions patterns in Spain for all ages to those in younger men.
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