Prostate cancer incidence and mortality in northern Germany

The cancer registry for the state of Schleswig-Holstein (the northernmost state of Germany), which has a  population of 2.8 million inhabitants, has recently reported data on the incidence and mortality of prostate cancer for the years 1999 through 2005.

According to Rhode et al.:

  • In 2000-01, 62.9 percent of prostate cancer patients were diagnosed with clinical stage I/II.
  • In 2004-05, 67.9 percent of prostate cancer patients were diagnosed with clinical stage I/II.
  • Between 1999 and 2003, the age-adjusted incidence increased by 30 percent.
  • Between 2003 and 2005, the age-adjusted incidence declined back down to the 1999 level.
  • Prostate cancer-specific mortality decreased continuously, and by 20 percent overall between 1999 and 2005.

The authors “assume that a selected group of men in Schleswig-Holstein has been screened regularly” in recent years through the use of PSA testing. They suggest that the rise in the incidence of prostate cancer between 1999 and 2003 could be interpreted as a typical effect of the early effects of widespread PSA-based screening. The decline in incidence after 2003 is therefore a normal consequence of the initial impact of widespread screening.

What is interesting is that prostate cancer-specific mortality has dropped continuously over the 6-year study period. We can not make the assumption that this is exclusively a consequence of PSA screening, but many are going to believe that earlier identification of the clinical problem increases the probability of early, curative treatment in the most appropriate patients. We shall just have to wait and see whether prostate cancer mortality in northern Germany continues to decline at this rate over the next 5 years or so.

7 Responses

  1. In Hamburg the doctors call the rubber glove inspection a Hafenrundfahrt — a tour of the harbour. :-)

  2. Most people don’t die of it in the first 5 years anyway. I wish they would hurry up and find some kind of cure for this … I’m really beginning to get pissed off.

  3. Where did the 20% come from, if most people don’t die of it in the first 5 years.

  4. Dear Chris:

    The 20% is not a reflection of the mortality rate of the people diagnosed within the 6 years of the study. It is an absolute reduction in prostate cancer mortality in the years that the study was carried out. So … in reference to this specific study, it may reflect a reduction in the mortality of men diagnosed in the period 5-10 years earlier (i.e., between 1990 and 1995).

    This is why we shall have to wait and see whether the mortality rate continues to decline.

  5. Although PSA screening eradicated advanced prostate cancer from the population, there was a downside.

    According to Welch’s report in August JNCI, 1 million men were … over-treated for prostate cancer over the last 20 years.

    Get the whole story here ….

  6. Exactly

  7. Dear Dr. Dach:

    Since The “New” Prostate Cancer InfoLink seeks to be an unbiased source of information, we had also commented on the paper by Welch and Albertsen. Please click here to see our report on that paper too!

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