Prostate cancer - UK incidence statistics

Prostate cancer is the most common cancer in men in the UK, accounting for a quarter of all new cases of cancer in males. In 2009, there were 40,841 cases of prostate cancer in the UK (Table 1.1).1-4 The crude incidence rate shows that there are around 135 cases for every 100,000 men.1-4

The European age-standardised incidence rates (AS rates) are significantly lower in Scotland compared with the other countries of the UK. Rates do not differ significantly between England, Wales and Northern Ireland (Table 1.1).1-4

A study from the 1990s showed remarkably little variation in prostate cancer incidence within the UK, with weak bands of slightly lower than average incidence across Northern Ireland and northern England, and slightly higher than average incidence across Wales, London and southern England.5 The most recent data for areas within the UK shows a mixed geographical pattern, with parts of Scotland having some of the lowest incidence rates.6

Table 1:1: Prostate Cancer (C61), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 population, UK, 2009

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*95% LCL and 95% UCL are the 95% lower and upper confidence limits around the AS Rate

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Prostate cancer incidence is strongly related to age. In the UK, between 2007 and 2009, an average three-quarters of prostate cancer cases were diagnosed in men aged 65 years and over (Figure 1.1).1-4

Figure 1.1: Prostate Cancer (C61), Average Number of New Cases per Year and Age-Specific Incidence Rates, UK, 2007-2009

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Age-specific incidence rates increase sharply from around age 50, peaking in men aged 75 and over.1-4 For men aged 55-59 the incidence rate is 161 per 100,000 men; ten years later, at age 65-69, the rate more than triples to 538 per 100,000, and by 75-79 the rate is almost five times higher at 781 per 100,000.

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Substantial increases in incidence have been reported in recent years for many countries around the world, including the UK.7

The prostate cancer incidence trend for the UK is shown in Figure 1.2. The European AS rate increased by almost half (48%) between 1993-1995 and 2003-2005. Rates have remained relatively stable since then, and increased by 3% between 2003-2005 and 2007-2009.1-4

Figure 1.2: Prostate Cancer (C61), European Age-Standardised Incidence Rates, UK, 1993-2009

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The trend for a longer time period is shown in Figure 1.3 for Great Britain. Overall the European AS rate increased by three times between 1975-1977 and 2007-2009, with the most rapid increases being seen in the early 1990s and late 1990s/early 2000s.1-3

Figure 1.3: Prostate Cancer (C61), European Age-Standardised Incidence Rates, Great Britain, 1975-2009

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The incidence trends for men aged up to 74 show similar patterns of overall increases since the mid-1970s (Figure 1.4). The largest increase has been in men aged 45-54, with the European AS rate increasing by eight times between 1975-1977 and 2007-2009. For men aged 85 and over, there has been a decrease in the rate since the mid-1990s (with a steep fall since the early 2000s), and the rate for men aged 75-84 has also decreased slightly since the early 2000s.1-3

Figure 1.4: Prostate Cancer (C61), European Age-Standardised Incidence Rates, by Age, Great Britain, 1975-2009

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Much of the increase in incidence (both in the UK and in many other countries worldwide) can be attributed to the incidental discovery of prostate cancers following transurethral resection of the prostate (TURP) and, more recently, the use of prostate specific antigen (PSA) testing.8 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 TURP, and afterwards through the rising use of PSA testing (Figure 1.5).9

Figure 1.5: Prostate Cancer (C61), Age-Standardised Rates of Transurethral Resection of the Prostate and Crude Rate of PSA testing, Scotland 1981-96

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Analyses for other countries, including the USA10,11 and Australia,12 have pointed to increased detection being a factor. In the USA, widespread PSA testing on asymptomatic men resulted in dramatic increases in incidence (an 82% rise among men aged 65 years and older between 1986 and 1991),11 and it is estimated that 75% of US men aged 50 years and older have had a PSA test.13 In Europe, the level of population screening is much lower, with published estimates of 10-20%.14

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The lifetime risk of developing prostate cancer is estimated to be 1 in 9 for men in the UK (calculated using 2008 data).15

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Although cancer registration has a long history in many countries of the world, particularly in the more affluent regions such as the UK, nearly 80% of the world’s populations live in regions that are not covered by such systems.16 Nonetheless, with a view to characterising the global burden of the disease, the International Agency for Research on Cancer routinely uses the available data to estimate worldwide cancer incidence.17

Prostate cancer is the fifth most common cancer in both sexes combined, estimated to account for 7% of all new cancer cases worldwide in 2008. In men, it is the second most common cancer after lung cancer, estimated to account for 14% of all new male cancer cases worldwide in 2008. Prostate cancer incidence rates are highest in Australia/New Zealand, and lowest in South-Central Asia, with a 25-fold variation in World AS incidence rates between the regions of the world (Figure 1.6). The developed countries carry the biggest burden of prostate cancer, accounting for nearly three-quarters (72%) of the total in 2008.17

Figure 1.6: Prostate Cancer (C61), World Age-Standardised Incidence Rates, World Regions, 2008 Estimates

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Within the 27 countries of the European Union (EU-27), the highest European AS incidence rates for 2008 are estimated to be in Ireland (183.2 new cases per 100,000) and the lowest in Greece (27.9 cases per 100,000) (Figure 1.7).18

UK prostate cancer incidence rates are estimated to be the 14th highest in Europe (EU-27).18

Figure 1.7: Prostate Cancer (C61), European Age-Standardised Incidence Rates, EU-27 countries, 2008 Estimates

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Rates of PSA testing have been shown to decrease with increasing levels of deprivation,19 and so it is not surprising that the incidence of prostate cancer is lower in the more deprived men. The most recent England-wide data for 2000-2004 shows European AS incidence rates are around 24% lower for men living in more deprived areas compared with the least deprived.20 Studies in Scotland and Northern Ireland have shown similar deprivation gaps,21,22 and lower incidence rates in the most deprived populations have also been published for Wales.23

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Prevalence refers to the number of people who have previously received a diagnosis of cancer and who are still alive at a given time point. Some patients will have been cured of their disease and others will not. The latest estimates for the UK (Table 1.2) show that around 181,000 men were still alive at the end of 2006, up to ten years after being diagnosed with prostate cancer.24 Worldwide, it is estimated that there were 3.2 million prostate cancer patients still alive in 2008, up to five years after their diagnosis.17

Table 1.2: Prostate Cancer (C61) Prevalence in the UK, at 31st December 2006

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