Trends in prostate cancer incidence and mortality to monitor control policies in a northeastern Brazilian state.

Carlos Anselmo Lima,Evânia Curvelo Hora,Marco Antonio Prado Nunes,Marcela Sampaio Lima,Marceli De Oliveira Santos,Marcia Maria Macedo Lima,Erika De Abreu Costa Brito,Brenda Evelin Barreto Da Silva,Angela Maria Da Silva,Hugo Leite De Farias Brito,Wen-Wei Sung

doi:10.1371/journal.pone.0249009

Carlos Anselmo Lima, Evânia Curvelo Hora + Show 9 more

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https://doi.org/10.1371/journal.pone.0249009

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Journal: PloS one	Publication Date: Mar 25, 2021
Citations: 4	License type: CC BY 4.0

Affiliation: Universidade Federal de Sergipe

Abstract

Prostate cancer differently affects different regions of the world, displaying higher rates in more developed areas. After the implementation of prostate-specific antigen (PSA) testing, several studies described rising rates globally, but it is possible that indolent lesions are being detected given the lack of changes in mortality data. The Brazilian government recommends against PSA screening in the male population regardless of age, but the Urology Society issued a report recommending that screening should start at 50 years old for certain men and for those aged ≥75 years with a life expectancy exceeding 10 years. In this study, we examined the incidence and mortality rates of invasive prostate cancer over time in the Sergipe state of Brazil. The databases of the Aracaju Cancer Registry and Mortality Information System were used to calculate age-standardized rates for all prostate tumors (International Classification of Diseases 10th edition: C61 and D07.5) in the following age ranges: 20-44, 45-54, and ≥65 years. We identified 3595 cases of cancer, 30 glandular intraepithelial high-grade lesions, and 3269 deaths. Using the Joinpoint Regression Program, we found that the incidence of prostate cancer dramatically increased over time until the mid-2000s for all age groups, after which the rates declined. Prostate cancer mortality rates increased until 2005, followed by a non-significant annual percent change of 22.0 in 2001-2005 and a stable rate thereafter. We noticed that the increases and decreases of the incidence rates of prostate cancer were associated with the screening recommendations. Meanwhile, the increased mortality rates did not appear to be associated with decreased PSA testing; instead, they were linked to the effects of age and improvements in identification of the cause of death. Thus, we do not believe a PSA screening program would benefit the population of this study.

Highlights

Prostate cancer (PCa) is associated with high incidence rates in developed countries and increasing rates in developing areas, especially in those in which prostate-specific antigen (PSA) testing is available for asymptomatic men [1]
PSA screening combined with ultrasound followed by guided biopsy is more likely to detect indolent lesions, which can lead to overdiagnosis, thereby inflating incidence statistics and overestimating the number of deaths attributable to PCa [5,6]
The analysis of trends of the incidence of PCa in the specified period (Table 3 and Fig 1) revealed marked growth until 2007, including annual percent change (APC) of 31.6 in 1996–1999 and 5.4 in 1999–2017

Summary

Introduction

Prostate cancer (PCa) is associated with high incidence rates in developed countries and increasing rates in developing areas, especially in those in which prostate-specific antigen (PSA) testing is available for asymptomatic men [1]. Most detected PCa lesions are low- to intermediate-grade tumors with slow progression, and only a small percentage of cases have a more aggressive course [2,3,4] For this reason, PSA screening combined with ultrasound followed by guided biopsy is more likely to detect indolent lesions, which can lead to overdiagnosis, thereby inflating incidence statistics and overestimating the number of deaths attributable to PCa [5,6]. Modern multiparametric magnetic resonance imaging (MP-MRI) fusion-guided biopsy is believed to better identify more aggressive lesions than standard techniques [7]. The age-standardized rate (ASR) of PCa per 100,000 men (standardized to the global population) varies by region, usually being higher in more developed regions (Oceania, 79.1; North America, 73.7; Europe, 62.1; South America, 60.4; Africa, 26.6; Asia, 11.5). A rate of 122.5 has been estimated for the state of Sergipe, including a rate of 81.9 in the capital Aracaju (incidence estimates not corrected for PSA screening; resulting in high figures) [9]

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