The Changing Age Distribution of Prostate Cancer in Canada

By Neutel, C. Ineke; Gao, Ru-Nie et al. | Canadian Journal of Public Health, January/February 2007 | Go to article overview

The Changing Age Distribution of Prostate Cancer in Canada


Neutel, C. Ineke, Gao, Ru-Nie, Blood, Paul A., Gaudette, Leslie A., Canadian Journal of Public Health


ABSTRACT

Background: Prostate cancer incidence rates are still increasing steadily; mortality rates are levelling, possibly decreasing; and hospitalization rates for many diagnoses are decreasing. Our objective is to examine changes in age distributions of prostate cancer during these times of change.

Methods: Prostate cancer cases were derived from the Canadian Cancer Registry, prostate cancer deaths from Vital Statistics, hospitalizations from the Hospital Morbidity File. Age-standardized rates were calculated based on the 1991 Canadian population. A prevalence correction for incidence rates was calculated.

Results: Age-specific incidence rates increased until 1995 for all ages, but a superimposed peak (1991-94) was greatest between ages 60-79. After 1995, increases in incidence continued for the under-70 age groups. Prevalence correction indicated the greatest underestimation of incidence rates for the oldest ages, but was less in Canada than in the United States. Mortality rates increased until 1994, then levelled and slowly decreased; age-specific mortality rates showed the greatest increase for the oldest ages but the earliest downturn for younger age groups. While hospitalizations dropped drastically after 1991, this drop was confined to elderly men (70+).

Conclusions: Dramatic changes in age distributions of prostate cancer incidence, mortality and hospitalizations altered age profiles of men with prostate cancer. This illustrated the changing nature of prostate cancer as a public health issue and has important implications for health care provision, e.g., the increased numbers of younger new patients have different needs from the increasing numbers of elderly long-term patients who now spend less time in hospital.

MeSH terms: Prostate cancer; age distribution; mortality; incidence; prevalence

Prostate cancer incidence rates have risen steadily in Canada over the past decades, except for a transient increase with a sharp peak in 1993 and subsequent decrease back to the previous trends.1,2 A similar peak in the United States (US) started a few years earlier, especially for Whites, and was larger, especially for African-Americans.3-7 This peak in incidence is generally attributed to PSA testing, which in Canada became available in 1986 and gained widespread use in the early 1990s.8 In the US, PSA use started earlier resulting in a slightly earlier peak.2,9,10 These changes in incidence rates may be likely accompanied by changes in prevalence, changes in use of hospital resources and, if earlier detection is effective, lead to lowering mortality rates. These changes may well have led to considerable changes in age distribution of the prostate cancer population.

The objective of this article is to determine whether changes in incidence, mortality and hospitalizations occurred uniformly for all age groups. Since prostate cancer is a common cancer among men, especially at older ages, and survival rates are long and increasing,11,12 the proportion of men with prostate cancer in the general population can be high. Since men diagnosed with prostate cancer are no longer at risk for becoming a new case, incidence rates may be underestimated. Merrill et al. applied prevalence corrections to US incidence rates and found that without these corrections, prostate cancer incidence was considerably underestimated, especially at the older ages.10 We will apply prevalence corrections to Canadian incidence rates to ascertain whether the same effect occurs in Canada.

METHODS

Incidence data for 1970-2001 were obtained from the Canadian Cancer Registry (CCR); in-patient hospital separations with a primary diagnosis of prostate cancer (ICD-9, 185) for 1980-2002 from the Hospital Morbidity File (HMF); and death registrations with prostate cancer as underlying cause of death for 1970-2002 from Vital Statistics Data (see statcan.ca for further information). All are maintained by Statistics Canada. …

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