EU Science Hub

Epidemiology of prostate cancer in Europe

Reliable information on the burden and outcome of cancer in a population are provided by population-based cancer registries (CR). CR uses multiple sources of information (hospital discharge notes, pathology reports, death certificates, etc.) to supply complete and solid data on cancer’s frequency and survival in defined populations. European CR, including those of the 28 member states of the European Union, are embraced in the European Network of Cancer Registries, a scientific association which provides recommendations on the classifications and procedures that CR should follow. Since 2013 ENCR is supported by the European Commission and the ENCR Secretariat is hosted at the Joint Research Centre in Ispra, Italy. ENCR-JRC has just launched a call for data, asking to about 150 regional and national European CR to contribute to its database hosted at the JRC. The CR will be able to upload the data via a web portal devised at JRC. Such a portal streamlines data entry and allows CR to participate in multiple studies avoiding duplicate submissions. In the European Union, prostate cancer is ranked first among the most frequently diagnosed cancer among men, with around 345,000 new cases estimated in 2012. Prostate cancer accounted for 24 per cent of all new cancers in the same year. For 2015 the estimated number of new prostate cancer cases is about 365,000. Within the European Union there is a huge variability in incidence rates, from Sweden (age-adjusted rate on the European standard population, ASR 175) to Greece (ASR 34). Although age standardized rates (ASRs) are still increasing in many countries, in some others they have started to flatten (e.g. USA, Denmark, Finland, Sweden, etc.). In the EU, about 72,000 deaths (10 per cent of the total cancer deaths) were estimated in 2012 and almost 77,000 are expected in 2015. ASR mortality rates vary across countries although to a lesser extent than incidence, from Lithuania (ASR mortality 36) to Malta (ASR 14). ASRs for prostate cancer mortality are decreasing in many countries. As regards five-year prevalence (number of people who have had a cancer diagnosis in the last 5 years), about 1,300,000 citizens of the European Union are estimated to have had a prostate cancer diagnosis in the last five years. They represent a burden for health services in terms of requests and needs for follow-ups. Concerning survival, the Eurocare project has compared cancer survival data among European countries since 1989. The on-going project – Eurocare 6 – has been launched in collaboration with ENCR-JRC through the ENCR-JRC web portal. The most recent data of the Eurocare project, on 5-year relative survival for cancers diagnosed in 2003-2007, show that prostate cancer ranked fourth in Europe among the cancers with the best prognosis with a 5-year relative survival of 83%. Survival varied from 88% in Southern and Central European countries to 76% in Eastern ones. Moreover, in all the European countries survival has increased over time with the highest improvement observed in the Eastern countries. (De Angelis et al. Lancet 2014) The epidemiology of prostate cancer has been strongly modified by the introduction and the widespread use of the Prostate Specific Antigen testing (PSA) and of the following diagnostic procedures (biopsy). PSA is a blood test highly sensitive to detecting a growth in the prostate tissue. In the USA, after its introduction in the late 80s, incidence rates had doubled in few years. A smaller but similar increase in prostate cancer incidence succeeded the introduction of PSA testing also in the other, mainly western-type, countries. PSA has been tested to evaluate its possible role as a screening test in healthy asymptomatic men. Unfortunately, although it turned effective in reducing prostate specific mortality, the relevant over diagnosis, – that is the diagnosis of indolent tumours which once diagnosed are treated as deadly cancers, – and the severe side effects of treatments, advised against the introduction of PSA as a screening programme. Any evaluation of the changes that have occurred in Europe in the last 15-20 years in the epidemiology of prostate cancer cannot be conducted without considering the role of PSA testing and the related amount of over diagnosis.