New global data on 5-year prostate cancer survival

A new study by Allemani et al., just published in The Lancet, has provided us with data from the largest ever global study of cancer survival, encompassing nearly 26 million people in 279 population-based registries from 67 countries around the world.

Data from this type of study must always be assessed with caution because — rather obviously — the quality and quantity of the available data vary significantly from country to country and registry to registry. However, there are some interesting facts about prostate cancer that can be extracted from this study. And the most interesting data come from Table 4 in the study, which looks at 5-year age-standardized net survival for people diagnosed with 11 different but relatively common forms of cancer — by continent, by country, and by calendar period of diagnosis. Prostate cancer is one of the types of cancer evaluated, and it should be noted that the total number of prostate cancer patients included in the study database was just under 5 million.

What rapidly becomes clear is that there seems to be a close association between the survival of men after a diagnosis of prostate cancer and the quality of accessible health care in the countries in which they live. This comes as no big surprise, because prostate cancer that is diagnosed late in the disease process is almost invariably metastatic and will lead to prostate cancer-specific death with high frequency, whereas prostate cancer that is diagnosed early is far more likely to be curable (assuming that it needs to be cured at all).

Interested readers will want to look at Table 4 themselves to get detailed information about specific nations. However, here are some exempletive data:

  • In Algeria, the 5-year prostate cancer-specific survival (5yPCSS) rate rose from about 44 percent (in 1995-99) to about 58 percent (in 2005-09).
  • In the Eastern Cape area of South Africa, the 5yPCSS rate was supposedly near to 100 percent in 2005-09 (up from about 84 percent in 2000-04), but a footnote comments that these data from this area of South Africa are “less reliable” than data from other registries.
  • In Chile, the 5yPCSS rate rose from about 70 percent (in 1995-99) to 91 percent (in 2005-09).
  • In India, the 5yPCSS rate was only about 36 percent in 2000-04 but rose to about 58 percent by 2005-09.
  • In Bulgaria, in Eastern Europe, the 5yPCSS rate rose from about 45 percent (in 1995-99) to about 52 percent (in 2005-09).
  • In the UK, the 5yPCSS rate rose from about 68 percent (in 1995-99) to about 83 percent (in 2005-09).
  • In China, the 5yPCSS rate changed very little, from about 63 percent (in 1995-99) to about 64 percent (in 2005-09).
  • Mongolia appears to have the lowest current 5yPCSS rate, at about 40 percent in 2005-09, among the nations for which data are available.
  • And for comparative purposes, the 5yPCSS rate in the USA rose from 93 percent (in 1995-99) to 97 percent (in 2005-09)

The good news would seem to be that there is not a single nation in which the 5yPCSS rate had fallen between 1995-99 and 2005-09, but clearly there are many nations around the world where better access to higher quality cancer care would probably save or at least extend lives.

The following paragraph provides the authors assessment of the data on prostate cancer presented in this study:

Striking increases in 5-year survival from prostate cancer have occurred in many countries, but global trends varied widely. Examples include three northern European countries, all with nationwide cancer registration. 5-year survival in Lithuania jumped from 52% for men diagnosed during 1995-99 to 92% for those diagnosed during 2005-09. The rise in Latvia was from 52% to 74%: access to health care in these countries has improved, and opportunistic PSA screening began in 2000. In Denmark, survival rose from 46% to 77% over the same period, having been stable at 40% throughout the period 1982-94, during which time survival increased rapidly in the other four Nordic countries. The Danish Urology Society advised against PSA testing in asymptomatic men in the early 1990s, but this advice is now followed less widely. By contrast, survival in North America and Oceania was already very high in the late 1990s, and increases since then have been much smaller. In Africa, we were unable to assess a trend.

2 Responses

  1. It would make a very interesting study in the PSA screening debate to correlate PSA uptake with 5yPCSS experience for each country.

    Because of sophisticated treatment and “limited” PSA screening, we have brought the US experience of 5yPCSS close to 100%. It is easy to forget there are many countries where the rate is still 50 to 70%, and Mongolia is even less — evidently fermented mare’s milk is not prophylactic!

  2. Rick:

    The use (or not) of the PSA test is far from being the only determinant of risk. A rather more important one (in places like Mongolia and sub-Saharan Africa) is whether you live within 100 miles of a doctor at all!

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