A 49% prostate cancer-specific mortality rate in the UK?

A report in The Daily Telegraph today states that “experts at King’s College London have now found the proportion of men with prostate cancer who actually die from it to be higher than previously thought.” Supposedly, the new research finding is that for 49 percent of 20,000 men diagnosed between 1997 and 2007 “prostate cancer was the principal cause of death.”

This report in The Daily Telegraph is based on a presentation being given today at the National Cancer Intelligence Network (NCIN) conference in London. One of the authors, Professor Henrik Moller, head of analysis and research at the NCIN, is reported to have said that, “Our findings challenge the commonly-held view that most men with prostate cancer will die with the disease rather than from it.”

Now we have not seen this presentation and we are not clear about assumptions that may have been built into the data analysis. However, what is clear is that this analysis is based on “records for 20,181 men with the disease who died between 1997 and 2007.” However, other UK data sources have long suggested that about 37,000 men are diagnosed each year in the UK, while about 10,000 men die from this condition each year (an annual incidence to mortality ratio of  about 3.7). Something doesn’t add up.

There is no doubt that the average man in the UK is less aware of his risk for prostate cancer than the average man in the USA today. Furthermore, the use of PSA testing has historically been low in the UK, implying that men in the UK are at increased risk for diagnosis with more advanced forms of prostate cancer. However, The “New” Prostate Cancer InfoLink still has a hard time believing that half of all men diagnosed with prostate cancer in the UK today are actually dying of this condition. If that was true, then more like 18,000 men should be dying of prostate cancer each year in the UK.

As far back as 1973, long before the availability of the PSA test, the age-standardized incidence rate for prostate cancer in the USA was about 75/100,000. Also in 1973, the age-standardized prostate cancer mortality rate in the USA was about 25/100,000. For Canada in 1973, the comparable incidence and mortality rates were about 60/100,000 and 24/100,000 respectively. These data give an annual incidence to mortality ratio of 3 in the USA and 2.5 in Canada in 1973. There has been little significant change in the age-standardized mortality rates in either country since that time, but the incidence rates have roughly doubled in both nations.

It makes no sense to us that the data in the UK would be so radically different, but there is little doubt that these data will cause at least a brief furore among the prostate cancer advocacy community in the UK. Prostate cancer is a very significant disease for every man diagnosed with this type of cancer, but it is not helpful to over-project the risk of prostate cancer-specific mortality. Men need an accurate understanding of their real, personal risks when diagnosed with prostate cancer — and those risks need to be based on the best possible evidence that is relevant to their individual clinical profile. Sending a message that half of all the men who get diagnosed with prostate cancer in the UK are going to die from this disorder is not helpful unless the evidence to support such a statement is overwhelming.

7 Responses

  1. There is a grey area that I have observed related to deaths of men with late stage disease. If a man gets pneumonia and dies from it because he does not have the strength to fight the pneumonia, would he have lived if he didn’t have the prostate cancer? Mets in the kidney may cause kidney failure. Cause of death is kidney failure, but without prostate cancer would there have been kidney failure? What about the men who die of heart attacks brought on by the stress of prostate cancer? Possibly what they did was look at secondary causes of death and use that also?

  2. Who knows? But if you die of pneumonia, you die of pneumonia. That’s true whatever the concomitant reasons for mortality. If you die of pneumonia as a very young child, with an underdeveloped immune system, no one suggests that the cause of death was “youth.”

  3. Your analysis is misguided. The study followed 50,066 men who had been diagnosed with prostate cancer over 10 years. In that period 20,181 men died, 40% of those studied. Of those that died, 49% were registered as died due to prostate cancer, which is only 20% of the men studied. (Of course, of those whose death was not registered as due to the cancer, it may still have been a major cause — there’s no way of knowing.)

    20% over 10 years is not so far out compared to the “37,000 men diagnosed each year and 10,000 deaths each year” quoted; which works out to 27% overall.

  4. Technically nobody dies from prostate cancer. They die from mets and complications of prostate cancer. As I said earlier there is greyness in what is put down as cause of death. If someone has advanced prostate cancer and his heart stops beating is it a heart attack or prostate cancer? It is clear if someone has early prostate cancer or prostate cancer that is under control and his heart stops, he dies of heart disease. Not so clear for a man with advanced disease. They used the phrase “advanced prostate cancer” several times in the article. It would be interesting to see more information about how they arrived at their figures.

  5. Dear Mr. Martin:

    Can you please provide a source for this information? The only source available to us this morning when we wrote this report was what was stated in The Daily Telegraph, which made no reference at all to a study population of 50,000+ patients diagnosed over a 10-year period. And we would respectfully point out that we questioned the information being provided in that source. Our “analysis” was therefore that we thought the information provided was dubious.

  6. More info may be available from the presentation in a couple of days. http://www.ncin.org.uk/home.aspx

  7. As a man who has stage IV prostate cancer and who realises that a simple blood test at the appropriate time (definition required) and just like the 11,000 men such as myself that continue to die each year. Why weren’t we offered or at least told we were the men most at risk? The reason we men with late-stage, incurable prostate cancer are angry is because we didn’t have the choice of turning down the PSA test. Women have the option of turning down a mammogram, so why can’t we have a manogram? I’ve lost a dear friend in Andy Ripley, the England Rugby International, and another good friend, Doug.

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