UK Prostate Cancer incidence statistics

Prostate cancer is the most common cancer in men in the UK - it accounts for nearly a quarter (24%) of all new male cancer diagnoses. Although there has been a huge rise in prostate cancer incidence over the last 20 years, this has not been reflected in mortality rates. Much of the increase in incidence is due to the incidental discovery of prostate cancer following transurethral resection of the prostate (TURP) and, more recently, the use of prostate specific antigen (PSA) testing.

In 2006, there were 35,515 new cases of prostate cancer diagnosed in the UK, that is around 97 men every day or one man every 15 minutes. Table 1.1 shows the numbers and rates of new cases in the UK and its constituent countries. 1-4 The lifetime risk of being diagnosed with prostate cancer is 1 in 10 for men in the UK. This was calculated in February 2009 using incidence and mortality data for 2001-2005 5

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Prostate cancer risk is strongly related to age: very few cases are registered in men under 50 and three-quarters of cases occur in men over 65 years.The largest number of cases is diagnosed in those aged 70-74 ( Figure 1.1). 1-4

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Prostate cancer incidence rates increase steeply with age and the highest rates occur in the oldest age groups. For men aged 55-59 the incidence rate per 100,000 men is 144; ten years later, at age 65-69, the rate more than triples to 500 per 100,000 and by 85+ the rate is more than five times higher at 789 per 100,000.

It is estimated from post-mortem data, that around half of all men in their fifties have histological evidence of cancer in the prostate, which rises to 80% by age 80, but only 1 in 26 men (3.8%) will die from this disease. 6, 7 In other words, men are more likely to die with prostate cancer than from it -an important fact when considering population screening of asymptomatic men. 8, 9

Nearly all prostate cancers are adenocarcinomas, mainly occurring in the peripheral zone of the prostate gland. 8

Deprivation incidence gradients have been reported for both and England and Wales and Scotland, with higher rates in the least deprived populations. 10-12,27 These deprivation gradients have widened during the 1990s due to the greater relative increase in incidence for men in the most affluent groups and are likely to be influenced by accessibility and uptake of PSA testing. 12

Worldwide, more than 670,000 men were diagnosed with prostate cancer in 2002, accounting for one in nine of all new cancers in males. 13 Unlike the UK, it is the second most common cancer in men after lung cancer worldwide.

Recent incidence rates are heavily influenced by the availability of PSA testing in the population and incidence varies far more than mortality. Three-quarters of all new cases are diagnosed in the developed world with the highest rates occurring in North America (specifically the USA) and the lowest rates in Asian countries ( Figure 1.2). 13

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One reason for the extremely high rate in the USA is the frequent use of PSA testing in that country. 14

Within the USA there are also significant differences between racial groups. Prostate cancer incidence rates for black Americans are more than 50% higher than for white Americans while rates for Asian Americans are 40% lower than for white Americans. In 2001-2005 the age-standardised (to the 2000 US population) incidence rate was 249 per 100,000 for black men, 157 per 100,000 for white men and 93.8 per 100,000 for Asian men. 15

Around 301,500 cases of prostate cancer were diagnosed in the 25 member countries of the EU (EU25) in 2006. 16 The lowest European rates are in southern and eastern Europe, and the highest rates are found in northern and western Europe ( Figure 1.3). 16

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A recent analysis of prostate cancer incidence and mortality within the UK and Ireland showed relatively little geographical variation. The availability and uptake of PSA testing across the country may have obscured the underlying variation in incidence. 17

Substantial increases in incidence have been reported in recent years for many countries around the world, including the UK. 18

During the last ten years in the UK, European age-standardised rates have increased by almost 40% from 71 per 100,000 in 1997 to 97 per 100,000 in 2006 while the numbers of cases diagnosed rose from 23,741 in 1997 to 35,515 in 2006, an increase of 50%.

Time trends for a longer period (1975-2006) are shown in Figure 1.4 for Great Britain, where the rates almost trebled from 33 per 100,000 in 1975 to 97 per 100,000 in 2006. 1-4 During the late 1970s and 1980s rates rose consistently, with an acceleration of the trend in the early 1990s followed by a brief levelling off in the mid-1990s another rising trend in the late 1990s.

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Prostate cancer incidence trends for the UK are shown in Figure 1.5.

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Incidence trends by age group show a similar pattern but with a fall in the 85+ rate, beginning in the mid-1990s and then steeply since 2001 ( Figure 1.6). 1-4 Between 1975 and 2006 the number of cases in Great Britain quadrupled from 8,042 in 1975 to 34,694 in 2006. 1-4

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An analysis of prostate cancer incidence trends in Scotland concluded that much of the apparent increase in cancer incidence between 1981 and 1996 was caused by increased detection: before 1989 through increasing rates of transurethral resection of the prostate (TURP) 19 and afterwards through the rising use of PSA testing ( Figure 1.720).Prostate cancer was an incidental finding in the tissue removed by TURP in around 10% of men.

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Analyses for other countries including the USA 21, 22 and Australia 23 have also pointed to increased detection being a factor.

In the USA widespread PSA testing on asymptomatic men from around 1986 resulted in dramatic increases in incidence (an 82% rise between 1986 and 1991) 22 and it is estimated that more than half of US white men aged over 50 have had their PSA level tested. 14

In western Europe the widespread use of PSA tests began a few years later, in around 1989-1990, but the level of population screening is much lower than in the USA. 24 In the UK it is estimated that between 5-6% of men over 40 have a PSA test each year. 25, 26

As the incidence of prostate cancer is high and five-year survival rates are around 70% many men are alive who have been diagnosed with prostate cancer. An estimated 215,000 men are alive in the UK having received a diagnosis of prostate cancer. The increase in prostate cancer prevalence may be partially influenced by the introduction of TURP and PSA testing, which has led to the detection of a greater proportion of latent, earlier, slow growing tumours.