Trends in incidence and mortality rates for prostate cancer before and after prostate-specific antigen introduction. A registry-based study in southeastern Netherlands, 1971-1995

The incidence of prostate cancer has increased considerably over the past two decades, partly due to the increased detection of subclinical cases. In southeastern Netherlands, a region of almost 1 million inhabitants with good access to specialised medical care, prostate-specific antigen (PSA) assays were not introduced until 1990, allowing us to investigate the nature of the increases in incidence. Age-adjusted (European Standardised Rate) and age-specific rates were calculated using incidence data from the population-based Eindhoven Cancer Registry and mortality data from Statistics Netherlands. The age-adjusted incidence, which increased from 36 per 100000 in 1971 to 55 per 100000 in 1989, included all grades as well as metastasised prostate cancer. The age-adjusted mortality mainly fluctuated in this period, but increased among men aged 55-64 years from 12 per 100000 in 1980 to 25 per 100000 in 1989. After 1990, the age-adjusted incidence further increased to 80 per 100000 in 1995, the increase representing mainly low-grade localised prostate cancer, presumably due to increasing opportunistic PSA testing, especially after 1993. A real increase in incidence may have occurred before 1993. However, pending results of randomised trials, judicious application of PSA testing seems justifiable to avoid unnecessary intervention without reducing mortality. (C) 1998 Elsevier Science Ltd. All rights reserved.