Health at a Glance
Prostate cancer trends in Canada, 1995 to 2012 Health at a Glance
Prostate cancer trends in Canada, 1995 to 2012

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by Lawrence Ellison

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Among males in Canada, prostate cancer is the most commonly diagnosed cancer and the third leading cause of cancer death, behind lung and colorectal cancers. With an estimated 21,105 new cases, prostate cancer accounted for 23.4% of all cancer cases diagnosed among males in 2012.^Note1 In that year, 9.5% (3,708) of all cancer deaths among men were from prostate cancer.

The prostate gland, which is part of the male reproductive system, is involved in producing semen.^{Note 2},^{Note 3} The most significant factor that increases a man’s risk of developing prostate cancer is older age.^{Note 2},^{Note 3} Another well-established risk factor is a family history of the disease.^{Note 2},^{Note 3}

This article presents national data on the annual rates of newly diagnosed cases of prostate cancer (incidence) and deaths attributed to this cancer (mortality) from 1995 to 2012. Trends in rates are presented for all ages combined and by age group. The age distribution of both prostate cancer incidence and prostate cancer mortality in 2012 is compared with corresponding data from 1995.

The data sources are the Canadian Cancer Registry (1995 to 2012), the Canadian Vital Statistics – Death Database (1995 to 2012) and population data, all from Statistics Canada.

Rate of newly diagnosed cases declining in recent years

The age-standardized incidence rate of newly diagnosed cases of prostate cancer decreased by 12.3% in 2012 from the year before. (Chart 1) The decline continues a trend towards increasingly lower prostate cancer incidence rates in recent years. From 2006 to 2012 the rate declined by an average of 3.8% per year. This followed an average increase of 1.1% per year from 1995 to 2006 (Table 1). Much of the peak in incidence in 2001 is considered to be because of intensified screening using the prostate-specific antigen (PSA) test, likely resulting in overdiagnosis.^{Note 4},^{Note 5},^{Note 6}

Prostate cancer incidence rates have also been declining over the last several years in the United States, but at a faster pace than in Canada. In particular, from 2011 to 2012, the rate in the United States decreased by 19.1%^{Note 7} compared with 12.3% noted for Canada. In the United States, the decline in the rate for 2012 coincides with a significant drop in self-reported PSA screening rates, possibly related to revised guidelines released by the United States Preventive Services Task Force.^{Note 8},^{Note 9},^{Note 10}

Steady declines in mortality rate over entire study period

From 1995 to 2012, the age-standardized mortality rate of prostate cancer decreased by an average of 2.9% per year. This corresponds to a 40.9% decline in the rate over this period. In the United States, the mortality rate for prostate cancer decreased by 47.4% over this 17-year period.^{Note 7}

While both screening and improvements in treatment have played a role in the decrease, the overall impact of PSA screening on prostate cancer mortality is thought to be small.^{Note 3},^{Note 4},^{Note 11} The slope and timing of the decline in prostate cancer mortality—dating back to 1991^{Note 4}—suggest that it cannot be “attributed mainly to PSA screening.”^{Note 4}

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Incidence rate of prostate cancer decreased in all age groups in recent years

The decline in the incidence rate of prostate cancer in recent years occurred in each age group examined (Chart 2). Among men aged 50 to 64 at diagnosis, rates decreased by an average of 3.6% per year from 2007 to 2012 (Table 1). Similar decreases were observed since 2006 among those aged 65 to 79 and since 2001 among those aged 80 and older.

Prostate cancer death rates declining over time across age groups

From 1995 to 2012, the mortality rate from prostate cancer significantly decreased in each age group studied (Chart 3, Table 1). Decreases were similar among men aged 50 to 64 (3.6% per year on average) and 65 to 79 (4.2%). Among men aged 80 and older, the rate of decrease was faster between 2004 and 2012 (an average decrease of 2.9% per year)—approximately double the average yearly rate of decrease from 1995 to 2004.

Changes in age-specific incidence rates

In 2012, the rate of newly diagnosed cases of prostate cancer increased steadily with age, from 6.3 per 100,000 men aged 40 to 44 to 556.9 per 100,000 men aged 65 to 69 (Chart 4).^{Note 16} Rates were relatively stable among older men, though an increase was seen between those in the 80-to-84 and 90-and-older age groups.

In comparison, the rates in 1995 were lower before the ages of 65 to 69, but continued to rise up to the ages of 85 to 89. Prostate cancer incidence rates were 40% to 44% lower among men in their 80s in 2012 than they were 17 years earlier. Prostate cancer was rarely diagnosed before the age of 40 in either period.

Prostate cancer diagnoses coming at younger ages

New prostate cancer cases in 2012 were diagnosed among younger men, as compared with new cases in 1995. The most common age at which men were diagnosed in 2012 was 64, whereas it was 69 in 1995. From 1995 to 2007, the median^{Note 17} age at diagnosis decreased from 71 to 67 and remained so through to 2012. The median age of prostate cancer deaths in 2012 was 82, up from 78 in 1995 (data not shown).

Prostate cancer was generally diagnosed at older ages in Canada than in the United States. For example, 20% of all new prostate cancer cases in the United States were diagnosed at age 75 or older in the period from 2008 to 2012^{Note 7} whereas in Canada this figure was 25% (data not shown).

The median age at diagnosis of prostate cancer in the United States from 2008 to 2012 was 66; for deaths attributed to this cancer, it was 80.^{Note 7}

Summary

Prostate cancer incidence rates have been decreasing in recent years; from 2006 to 2012 the rate decreased by an average of 3.8% per year. From 1995 to 2012 the prostate cancer mortality rate decreased by an average of 2.9% per year. Mortality rates decreased at a faster pace among men aged 50 to 79 than among those aged 80 and older.

Men diagnosed with prostate cancer in 2012 were younger at diagnosis than they were in 1995, while deaths attributed to this cancer occurred at older ages in 2012, compared with 1995.

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