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

by Lawrence Ellison

Release date: April 25, 2016

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Highlights

  • 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.
  • The rate of newly diagnosed cases of prostate cancer increased by an average of 1.1% per year from 1995 to 2006 and then decreased by an average of 3.8% per year from 2006 to 2012.
  • The rate of deaths from prostate cancer decreased by an average of 2.9% per year from 1995 to 2012. This corresponds to a 41.0% decline in the rate over this period.
  • From 1995 to 2012, the median age at diagnosis for prostate cancer decreased from 71 to 67, while the median age of prostate cancer death increased from 78 to 82.

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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

Table 1
Trends in prostate cancer age-standardized incidence and mortality rates, selected age groups, annual percent change (APC), Canada, 1995 to 2012
Table summary
This table displays the results of Table 1 Trends in prostate cancer age-standardized incidence and mortality rates. The information is grouped by Age group (years) (appearing as row headers), Trend 1, Trend 2, Trend 3, Period, Annual percent change and 95% confidence interval, calculated using from and to units of measure (appearing as column headers).
Age group (years) Trend 1 Trend 2 Trend 3
Period Annual percent change 95% confidence interval Period Annual percent change 95% confidence interval Period Annual percent change 95% confidence interval
from to from to from to
Incidence  
All ages 1995 to 2006 1.1Note * 0.2 2.0 2006 to 2012 -3.8Note * -5.6 -1.9 Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable
50 to 64 1995 to 2001 7.1Note * 5.2 9.1 2001 to 2007 1.7 -0.1 3.6 2007 to 2012 -3.6Note * -5.2 -2.0
65 to 79 1995 to 2006 0.4 -0.6 1.4 2006 to 2012 -4.1Note * -6.3 -1.8 Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable
80 and older 1995 to 2001 -1.3 -2.6 0.1 2001 to 2012 -3.5Note * -3.9 -3.0 Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable
Mortality  
All ages 1995 to 2012 -2.9Note * -3.1 -2.7 Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable
50 to 64 1995 to 2012 -3.6Note * -4.1 -3.1 Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable
65 to 79 1995 to 2012 -4.2Note * -4.6 -3.9 Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable
80 and older 1995 to 2004 -1.4Note * -1.9 -1.0 2004 to 2012 -2.9Note * -3.4 -2.4 Note ...: not applicable Note ...: not applicable Note ...: not applicable Note ...: not applicable

Chart 1 Age-standardized prostate cancer incidence and mortality rates, by year, Canada, 1995 to 2012

Description for Chart 1
Data table for Chart 1
Table summary
This table displays the results of Chart 1 Age-standardized prostate cancer incidence and mortality rates. The information is grouped by Year (appearing as row headers), rate, 95% LL, 95% UL, low and high, calculated using Incidence and Mortality units of measure (appearing as column headers).
Year Rate Lower 95% confidence interval Upper 95% confidence interval
Incidence  
1995 149.4 146.9 151.9
1996 146.7 144.3 149.1
1997 154.1 151.6 156.6
1998 153.9 151.5 156.3
1999 159.8 157.3 162.2
2000 166.5 164.0 168.9
2001 177.6 175.1 180.1
2002 165.4 163.0 167.8
2003 161.2 158.9 163.5
2004 164.2 161.9 166.5
2005 163.7 161.5 166.0
2006 169.3 167.1 171.6
2007 168.2 166.0 170.4
2008 154.8 152.7 156.9
2009 151.4 149.4 153.4
2010 146.1 144.2 148.0
2011 148.6 146.6 150.5
2012 130.3 128.5 132.1
Mortality  
1995 45.1 43.6 46.7
1996 42.6 41.1 44.0
1997 41.9 40.5 43.4
1998 41.0 39.6 42.4
1999 39.6 38.3 41.0
2000 39.6 38.3 41.0
2001 39.8 38.5 41.1
2002 37.5 36.3 38.8
2003 36.3 35.1 37.6
2004 35.5 34.3 36.7
2005 33.4 32.2 34.5
2006 32.2 31.1 33.3
2007 31.7 30.6 32.8
2008 31.0 30.0 32.1
2009 30.2 29.2 31.1
2010 29.9 28.9 30.8
2011 27.8 26.9 28.8
2012 26.7 25.8 27.5

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 1991Note 4—suggest that it cannot be “attributed mainly to PSA screening.”Note 4

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The PSA screening test

Screening for cancer can help save lives by detecting some types of cancer early, when the disease is more responsive to treatment. The PSA test is a blood test for a protein produced by the prostate called the prostate specific antigen. In general, the higher the PSA level the greater the chance that prostate cancer is present.

Coinciding with the increasingly common use of the PSA test in the early 1990s, the annual rate of newly diagnosed cases in Canada increased by approximately 40% between 1990 and 1993, and then decreased by about 20% over the next two years.Note 4,Note 5,Note 12 While the PSA test can help detect prostate cancer early, its usefulness as a screening test has not been proven—it has not been shown to result in a reduction in all-cause mortality.Note 13,Note 14

For men who have symptoms associated with prostate cancer, the PSA blood test is one of the first tests that they are likely to undergo. The test is considered to be “an important part of monitoring prostate cancer during and after treatment.”Note 15

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.

Chart 2 Age-specific prostate cancer incidence rates, by year, selected age groups, Canada, 1995 to 2012, rate (per 100,000 men)

Description for Chart 2
Data table for Chart 2
Table summary
This table displays the results of Chart 2 Age-specific prostate cancer incidence rates. The information is grouped by Year (appearing as row headers), rate, 95% LL, 95% UL, low and high, calculated using 50 to 64, 65 to 79 and 80+ units of measure (appearing as column headers).
Year of diagnosis Rate Lower 95% confidence interval Upper 95% confidence interval
50 to 64 years  
1995 164.2 158.6 169.8
1996 173.3 167.6 179.0
1997 187.0 181.1 192.8
1998 199.9 193.9 205.9
1999 212.0 205.9 218.1
2000 226.8 220.5 233.0
2001 259.9 253.4 266.5
2002 247.7 241.5 254.0
2003 245.6 239.5 251.7
2004 255.5 249.5 261.6
2005 256.8 250.9 262.8
2006 276.3 270.2 282.3
2007 279.3 273.4 285.3
2008 257.3 251.7 262.9
2009 250.9 245.5 256.3
2010 238.7 233.5 243.9
2011 247.9 242.7 253.1
2012 221.3 216.4 226.2
65 to 79 years  
1995 718.2 703.0 733.4
1996 703.6 688.8 718.4
1997 740.2 725.2 755.2
1998 711.0 696.5 725.5
1999 751.5 736.7 766.3
2000 781.3 766.3 796.2
2001 822.0 806.7 837.2
2002 752.1 737.6 766.5
2003 725.7 711.6 739.8
2004 738.5 724.4 752.7
2005 731.2 717.2 745.1
2006 754.6 740.6 768.7
2007 757.9 744.0 771.8
2008 685.8 672.7 698.8
2009 665.2 652.5 677.8
2010 654.0 641.6 666.4
2011 656.3 644.1 668.5
2012 563.2 552.1 574.3
80 years and older  
1995 997.6 958.2 1037.0
1996 920.1 882.9 957.3
1997 935.2 898.2 972.2
1998 936.0 899.5 972.5
1999 909.8 874.1 945.6
2000 916.9 881.6 952.2
2001 906.1 871.9 940.2
2002 844.8 812.7 877.0
2003 817.7 786.7 848.7
2004 800.6 770.6 830.6
2005 800.9 771.4 830.3
2006 773.1 745.0 801.2
2007 713.9 687.6 740.2
2008 687.8 662.5 713.1
2009 684.0 659.4 708.6
2010 648.8 625.4 672.2
2011 649.2 626.3 672.2
2012 587.5 566.1 608.9

Chart 3 Age-specific prostate cancer mortality rates, by year, selected age groups, Canada, 1995 to 2012, rate (per 100,000 men)

Description for Chart 3
Data table for Chart 3
Table summary
This table displays the results of Chart 3 Age-specific prostate cancer mortality rates. The information is grouped by Year (appearing as row headers), rate, 95% LL, 95% UL, low and high (appearing as column headers).
Year of death Rate Lower 95% confidence interval Upper 95% confidence interval
50 to 64 years  
1995 14.6 13.0 16.3
1996 13.6 12.0 15.2
1997 13.5 11.9 15.1
1998 11.8 10.3 13.2
1999 11.0 9.7 12.4
2000 11.6 10.2 13.0
2001 11.0 9.6 12.3
2002 12.1 10.7 13.5
2003 10.9 9.6 12.2
2004 9.6 8.4 10.8
2005 9.9 8.7 11.0
2006 9.0 7.9 10.1
2007 8.5 7.4 9.5
2008 8.8 7.7 9.8
2009 8.3 7.3 9.3
2010 7.7 6.7 8.6
2011 7.7 6.8 8.6
2012 8.1 7.1 9.0
65 to 79 years  
1995 155.3 148.1 162.5
1996 138.7 132.0 145.3
1997 136.6 130.1 143.1
1998 135.2 128.8 141.5
1999 128.4 122.3 134.5
2000 131.1 125.0 137.2
2001 127.4 121.5 133.4
2002 115.3 109.7 121.0
2003 107.4 102.0 112.8
2004 102.1 96.9 107.3
2005 95.1 90.1 100.1
2006 89.8 85.0 94.6
2007 87.9 83.2 92.6
2008 88.2 83.6 92.9
2009 85.4 80.9 89.9
2010 84.0 79.5 88.4
2011 77.4 73.2 81.6
2012 71.1 67.1 75.1
80 years and older  
1995 657.0 624.2 689.9
1996 641.3 609.1 673.5
1997 631.1 599.5 662.6
1998 620.5 589.9 651.0
1999 607.7 577.7 637.7
2000 598.2 568.8 627.5
2001 614.7 585.5 643.9
2002 582.7 554.9 610.6
2003 580.8 553.4 608.1
2004 582.0 555.2 608.7
2005 542.7 517.5 568.0
2006 532.5 508.0 557.0
2007 528.4 504.6 552.2
2008 508.4 485.7 531.0
2009 494.9 473.1 516.7
2010 494.6 473.4 515.8
2011 461.6 441.7 481.4
2012 447.0 428.0 466.0

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.

Chart 4 Age-specific prostate cancer incidence rates, ages 40 and older, Canada, 2012 versus 1995, rate (per 100,000 men)

Description for Chart 4
Data table for Chart 4
Table summary
This table displays the results of Chart 4 Age-specific prostate cancer incidence rates. The information is grouped by Year (appearing as row headers), rate, 95% LL, 95% UL, low and high, calculated using 1995 and 2012 units of measure (appearing as column headers).
Age group (years) Rate Lower 95% confidence interval Upper 95% confidence interval
1995  
40 to 44 1.9 1.2 2.9
45 to 49 10.8 8.9 13.0
50 to 54 47.8 43.1 52.9
55 to 59 145.7 136.5 155.4
60 to 64 338.1 323.4 353.2
65 to 69 588.9 568.4 610.1
70 to 74 765.9 739.7 792.9
75 to 79 873.9 838.9 909.9
80 to 84 921.8 876.3 969.2
85 to 89 1078.9 1003.9 1158.1
90 and older 1082.8 964.5 1211.6
2012  
40 to 44 6.3 4.9 7.8
45 to 49 25.1 22.5 28.0
50 to 54 98.6 93.4 104.0
55 to 59 216.0 207.8 224.5
60 to 64 388.4 376.4 400.8
65 to 69 556.9 540.5 573.7
70 to 74 583.0 563.0 603.5
75 to 79 549.0 526.8 571.9
80 to 84 551.3 524.9 578.8
85 to 89 600.9 562.7 641.1
90 and older 678.0 614.1 746.7

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 medianNote 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 2012Note 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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Data sources, methods and definitions

Data sources

The Canadian Cancer Registry is a dynamic, person-oriented, population-based database maintained by Statistics Canada. It contains information on cancer cases diagnosed from 1992 onward, compiled from reports from every provincial and territorial cancer registry in Canada. Cancer incidence data in this report are from the February 2016 tabulation master file. The analysis file was created using the multiple primary coding rules of the International Agency for Research on Cancer.Note 18 Cases were defined based on the International Classification of Diseases for Oncology, Third Edition.Note 19

The Canadian Vital Statistics – Death Database includes demographic and cause of death information for all deaths from all provincial and territorial vital statistics registries in Canada. Prior to 2010, some data were collected on Canadian residents who died in some American states; these deaths were excluded from this analysis. Starting with the 2010 reference year, data on Canadian residents who died in American states are no longer collected. Mortality data in this report are from the December 10, 2015, release.

Incidence and mortality rates were derived using Canada’s population estimates by age and sex.Note 20

Methods

Classification of cases and deaths
Cancer cases were classified as prostate cancer if the topography (site) code was C61.9 and the histology code was within one of the following ranges: 8000- to 9049, 9056- to 9139 or 9149- to 9589. Only malignant cases were considered.

Deaths were classified using the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems—10th Revision (ICD-10)Note 21 for deaths from the year 2000 onward, and the 9th Revision (ICD-9)Note 22 for deaths from previous years. Deaths for which the ICD-10 code was C61 or the ICD-9 code was 185 were considered to be from prostate cancer.

Incomplete data
At the time of the analyses, cancer data for Quebec were not available beyond 2010. The 2010 data from this province were copied and used as a substitute for both 2011 and 2012. This approach was considered preferable to excluding Quebec data for these years because prostate cancer incidence in Quebec is not similar to that in the rest of Canada.Note 5,Note 23

Death certificate only cases had not been reported for Ontario since 2007 and for Quebec since 2009. In each instance, incidence data from the last year in which they were reported were repeated for subsequent years.

Trend analyses
All trend analyses were performed using the Joinpoint Regression Program of the Surveillance, Epidemiology, and End Results (SEER) Program and age-standardized rates.Note 24 Unless otherwise noted, the annual changes in age-standardized incidence and mortality rates reported in this article are the annual percent changes (APCs). If statistically significant changes in trends were detected in the study period, then multiple APCs were reported. The minimum time span on which to report a trend was set at five years. Thus, the most recent possible trend period in this study was 2008 to 2012. The critical level used to determine whether a given trend was significantly increasing or decreasing was set at 0.05.

Age-standardized rates were standardized to the final postcensal estimates of the July 1, 2011, Canadian population (see table below).

2011 Canadian standard population weights
Table summary
This table displays the results of Age-standardized rates were standardized to the final postcensal estimates of the July 1. The information is grouped by Age group (appearing as row headers), Standard weight (appearing as column headers).
Age group Standard weight
0 to 4 0.055297
5 to 9 0.052717
10 to 14 0.055853
15 to 19 0.065194
20 to 24 0.068555
25 to 29 0.069006
30 to 34 0.067786
35 to 39 0.066188
40 to 44 0.069474
45 to 49 0.079199
50 to 54 0.078365
55 to 59 0.068518
60 to 64 0.059705
65 to 69 0.044636
70 to 74 0.033597
75 to 79 0.026769
80 to 84 0.020416
85 to 89 0.012426
90 and older 0.006299

Definitions

The age-standardized incidence or mortality rate represents the number of new cancer cases or deaths per 100,000 men that would have occurred if the population under study had had the same age distribution as the given standard population. Age-standardization allows for comparisons of incidence or mortality rates over time that are unaffected by changes in the age distribution of the population. All reported incidence and mortality rates were age-standardized.

Overdiagnosis refers to the detection of disease that would not progress to cause symptoms or death.Note 4 ,Note 25

Screening refers to testing to find a disease in people who don’t have symptoms of that disease.Note 26

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Related material for this article

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