Epidemiology of Prostate Cancer in Europe: Patterns, Trends and Determinants
Prostate cancer is a substantial public health problem worldwide. It is the most common neoplasm among men and third-ranked cause of cancer death in Europe, with almost 400,000 cases and over 92,000 deaths. Beginning in the early to mid-1990s, the PSA-ind
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Introduction
Malignant neoplasms of the prostate, hereafter referred to as prostate cancer (ICD-10 C61), usually originate in the glandular tissue. While these cancers, mainly adenocarcinomas, are often indolent, there is a subset of men who are diagnosed with highly malignant prostate cancers associated with poor prognosis. The disease poses a substantial public health burden worldwide and in Europe: it is the second most frequently diagnosed cancer and the fifth leading cause of cancer death among men globally, with an estimated 1.1 million new cases diagnosed and 307,000 deaths from the disease in 2012 [16]. Among European men, it is the most common neoplasm and thirdranked cause of cancer death, with almost 400,000 cases and over 92,000 deaths Incidence rates of prostate cancer are heavily influenced by the diagnosis of latent cancers by serum prostate-specific antigen (PSA) testing of asymptomatic individuals, and by the detection F. Bray (*) Section of Cancer Surveillance, International Agency for Research on Cancer, 150, Cours Albert Thomas, F-69372 Lyon Cedex, Lyon, France e-mail: [email protected] L.A. Kiemeney Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence & Department of Urology, Nijmegen, The Netherlands
of latent cancer in tissue removed during prostatectomy operations, or at autopsy. When PSA became commercially available in the mid-1980s in the USA and the late 1980s in Europe, the intensive use of the test by general practitioners and urologists as an early detection and diagnostic tool led to inflated incidence rates first in the USA [21] and within a few years in Greater Europe, notably in several Nordic countries [26]. During the early to mid-1990s, the detection of a substantial number of early-stage prostate cancers brought about rapid increases in population- level incidence rates across the higher-income countries of Northern, Western and Southern Europe. The extent to which prostate cancer incidence is now (as estimated in 2012) the leading form of cancer occurrence in men in these regions can be visibly grasped in Fig. 1. An East–west divide can be seen in Europe that combines differences in diagnostic intensity and the prominent cause of cancer in the region: in Central and Eastern Europe, PSA testing has been historically lower but male tobacco consumption higher and declining later, relative to elsewhere in Europe. Indeed, lung cancer remains the leading cancer in the eastern areas of Europe, prostate cancer in the west. In contrast, only in Sweden is prostate cancer the leading cause of cancer death, a country in which the male population did not take up the smoking habit like neighbouring countries; lung cancer ranks as the most important form of cancer death in men in all of the 39 remaining countries in Europe.
© Springer International Publishing Switzerland 2017 M. Bolla, H. van Poppel (eds.), Management of Prostate Cancer, DOI 10.1007/978-3-319-42769-0_1
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F. Bray and L.A. Kiemeney
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Prostate (24) Lung (15) Colorectum (1)
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