Trends and projections in prostate cancer epidemiology in Thailand: A population-based cancer registry analysis

Abstract

Objective

This study aimed to investigate trends in the incidence and mortality of prostate cancer (PCa) in Thailand from 1990 to 2017 and project future rates up to 2040. It also aimed to examine incidence and mortality trends across 12 health districts and Bangkok from 2012 to 2020.

Methods

Data on PCa cases diagnosed between 1990 and 2017 were obtained from Thailand's Population-based Cancer Registry. Age-specific incidence rates were adjusted to the Segi World Standard Population as recommended by the WHO. The joinpoint regression analysis identified significant changes in trends and estimated the annual percent change. Projections were made using the joinpoint regression model. District-specific incidence rates and mortality rates from 2012 to 2020 were calculated for 12 health districts and Bangkok.

Results

From 1990 to 2017, 18 192 new PCa cases were diagnosed in Thailand, with 95% in men aged 50 years and older. The age-standardised incidence rate more than doubled from 3.84 to 7.72 cases per 100 000 person-years, with a significant estimated annual percent change of 2.7% (95% CI 1.7%–4.1%; p<0.05). Projections indicated the age-standardised incidence rate for men aged 50 years and older would rise from 8.3 cases per 100 000 person-years in 2018 to 15.4 by 2040. The 12 health districts and Bangkok showed variable incidence rates, with significant increases in several districts and fluctuating mortality rates (p<0.05).

Conclusion

PCa incidence rates and mortality rates in Thailand have significantly increased over the past decades. With an aging population, these trends are expected to continue, posing a growing public health challenge. These findings highlight the urgent need for effective cancer control strategies and updated epidemiological data to support policy-making.

1. Introduction

Prostate cancer (PCa) is the second most frequently diagnosed cancer globally and the fifth leading cause of cancer-related deaths among men, with approximately 1.4 million cases and 375 000 deaths recorded in 2020. It is the most diagnosed cancer in 112 countries and the leading cause of cancer mortality in 48 nations [1]. These significant incidence and mortality rates (MRs) show PCa as a substantial global health concern. Advanced age is a critical risk factor, with over 85% of diagnoses occurring in men aged 60 years and above [1,2]. Factors such as aging populations and economic development are expected to increase the burden of this disease. By 2030, the global burden of PCa is projected to rise to 1.7 million new cases and nearly 499 000 deaths, primarily due to population growth and aging [3,4].

The incidence of PCa varies significantly by over 25-fold across the globe, with significant disparities noted between different geographical areas. This variance is largely influenced by the prevalence of prostate-specific antigen (PSA) testing and differing guidelines from international and national health organizations [5]. Countries and regions including Australia, New Zealand, and North American countries had the highest age-standardized incidence rates (ASRs): 111.6 cases per 100 000 people for Australia and New Zealand, and 97.2 cases per 100 000 people for North American countries, while ASRs were considerably lower in Eastern and South-Central Asian countries and regions (10.5 cases and 4.5 cases per 100 000 people, respectively), although an upward trend has been observed in these countries and regions [6]. Apart from PSA testing, the incidence of PCa also depends on factors such as the age distribution of the population, geographical location, and ethnic background.

In Asian countries, the incidence of PCa remains lower than that in Western countries, but has seen a sharp increase in recent years. For example, East Asian countries experienced an average annual increase of 7.2% in the incidence rate from 2005 to 2009 [7]. MRs also showed upward trends in some Asian countries, including a 13.4% yearly increase in the Republic of Korea from 1985 to 2002 [8,9]. These rising figures may reflect the effects of an aging population, evolving lifestyles, and improved healthcare access due to economic advancement.

In Thailand, the nationwide incidence of PCa has been increasing, with an average annual increase of 2.7% over the last two decades [8]. The mean annual ASR rose from 4.9 cases per 100 000 person-years between 2010 and 2012 to 7.5 cases per 100 000 person-years between 2013 and 2015 [10,11]. Given the current trends in increasing life expectancy and the existing age-specific incidence and MRs, PCa is expected to become a far greater public health problem in the future. Updated epidemiological data are crucial to helping policymakers and concerned authorities plan and formulate sound cancer control strategies based on scientific and empirical evidence. This study aimed to investigate the trend in the incidence of PCa using national data from the Thailand Population-Based Cancer Registry from 1990 to 2017, project PCa rates up to 2040, and analyse the district-specific trend in incidence and mortality of PCa from 2012 to 2020.

2. Materials and methods

2.1. Study population

Thailand, a Southeast Asian country, has a population of 65.4 million, with men accounting for 49.08% [12]. According to the Thai National Statistical Office, approximately 20% of Thailand's population is aged 60 years or older, with men having a life expectancy of 75 years [12,13]. There are 77 provinces in the country, which is geographically divided into four main regions; Bangkok is the capital city. The study population was categorized into health districts, consisting of 12 health districts and Bangkok, which serve as key areas for the National Cancer Control Program of Thailand (Thailand NCCP) [14]. Details are in Supplementary Table 1. The population denominators used to calculate incidence rates were obtained from the population projections report for Thailand [14].

2.2. Data collection and data analysis

The cancer registry is a key part of the Thailand NCCP, covering the 16 most populous provinces [15], which is a cornerstone of the Thailand NCCP and covers the population through high-quality registries that track cancer incidence and outcomes across the country. Data collection is supported by seven regional cancer hospitals, which work closely with the National Cancer Institute of Thailand, Department of Medical Services, Ministry of Public Health to ensure data completeness and accuracy.

PCa incidence and mortality data from 1990 to 2017 were obtained from the Thailand Population-Based Cancer Registry, in accordance with the standards of by the International Agency for Research on Cancer. The data were collected from several sources: hospitals, which reported cancer diagnoses and treatment outcomes; diagnostic laboratories, which confirmed the pathology of PCa; and death certificates, which were actively monitored to ensure accurate mortality reporting related to PCa. This multifaceted approach ensured that the registry captures a comprehensive dataset, representing a wide cross-section of the Thai population [14].

PCa cases were identified using the International Classification of Diseases, 10th revision (ICD-10) code C61 for malignant neoplasm of the prostate. Data collection was conducted primarily through active methods, meaning that hospitals and other healthcare facilities actively contributed data to the registry to ensure full coverage and minimize under-reporting.

2.3. Statistical analysis

Age-specific incidence rates of PCa were calculated across 10 calendar periods spanning from 1990 to 2017, using nine 3-year intervals and one final 1-year interval (2017), grouped into 5-year age groups, all adjusted to the Segi World Standard Population. Incidence and MRs for comparison were similarly standardized [16]. Data from the 12 health districts and Bangkok were analyzed from 2012 to 2020 using 1-year intervals, reported as crude incidence rates (CIRs) and MRs.

Joinpoint regression analysis identified trends in ASRs, CIRs, and MRs for PCa using the Joinpoint Regression Program version 5.2.0 (Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute, Bethesda, MD, USA). This method calculates the estimated annual percent change (EAPC) and the average annual percent change (AAPC) using a Monte Carlo permutation method with a significance level of 0.05. Analyses covered all males, with a specific focus on those aged 50 years and older to discern incidence trends among individuals of an age commonly associated with a higher risk for PCa.

The Age-Period-Cohort model was used to examine the effects of age, period, and cohort on national PCa incidence rates for males aged 50 years and older. This model was analyzed using the Age-Period-Cohort Web Tool developed by the Biostatistics Branch of the National Cancer Institute, Bethesda, MD, USA [17]. The model provides estimates of age-specific incidence rates, cohort rate ratios, period rate ratios, and drift parameters (net drift and local drifts), with statistical significance evaluated using the Wald test.

For projecting the PCa incidence rates in Thailand up to 2040, only the joinpoint regression model was used due to data inconsistencies. Projections, focused on males aged 50 years and older, included validation and determination of 95% prediction intervals (PIs), using 2017 as the base year. The model employed EAPCs derived from the joinpoint regression analysis.

2.4. Ethical considerations

Approval to access anonymized and aggregated cancer data was obtained from the National Cancer Institute of Thailand, Department of Medical Services, Ministry of Public Health. The research protocol was thoroughly reviewed and approved by the Ethics Committee of the National Cancer Institute of Thailand (approval number: EC67001).

3. Results

3.1. National incidence and subgroup analysis for males aged 50 years and over

There were 18 192 new cases diagnosed with PCa in Thailand between 1990 and 2017, with 95% (17 240) cases diagnosed in males aged 50 years or older. The PCa incidence rate in Thailand increased significantly from 1990 to 2017 at an EAPC of 2.7% (95% confidence interval [CI] 1.7%–4.1%; p<0.05). The ASR increased more than two-fold, from 3.84 to 7.72 cases per 100 000 person-years over the study period (Fig. 1). Among 5-year age groups, the highest age-specific incidence rate was observed in the 70–74 age group (37.40–95.24 per 100 000 person-years), while the open-ended ≥75 age group showed even higher rates (Fig. 2). Among males aged 50 years and over, the ASR showed a significant upward trend, with an overall ASR of 5.82 per 100 000 person-years. Joinpoint regression further indicated a significant increasing trend in this ≥50-year age group (Supplementary Fig. 1), with an EAPC of 2.9% (95% CI 1.8%–4.3%; p<0.05).

Figure 1.

ASR of prostate cancer among males aged ≥50 years in Thailand, 1990–2017, estimated using joinpoint regression analysis. ASR, age-standardized incidence rate.

Figure 2.

The age-specific incidence rate of prostate cancer (per 100 000 person-years) from 1990 to 2017.

3.2. Age-Period-Cohort model

The Age-Period-Cohort model analysis revealed a significant trend in PCa incidence rate in Thailand. The age-specific incidence rates for males aged 50 years and older from 1990 to 2017 generally increased with age, from 2.82 (95% CI 2.06–3.85) per 100 000 person-years at age 53 years to 117.33 (95% CI 99.89–137.82) per 100 000 person-years at age 78 years (Fig. 3A).

Figure 3.

Age-Period-Cohort model. (A) The cross-sectional age curve; (B) The cohort model; (C) The period model; (D) The net drift and local drift.

Fig. 3B showed the cohort rate ratio of PCa from 1925 to 1964. The cohort rate ratios indicated a trend in PCa risk across different birth cohorts. The 1925 cohort had a rate ratio of 0.72 (95% CI 0.48–1.08), while the 1931 cohort had a lower rate ratio of 0.69 (95% CI 0.53–0.89). The risk increased significantly for cohorts born after 1946, with the 1964 cohort showing a rate ratio of 2.66 (95% CI 1.33–5.32). The Wald test showed statistically significant differences among the cohort rate ratios (p<0.001).

The period effect showed fluctuations in PCa incidence rate over different calendar periods (Fig. 3C). The period rate ratio for 1992 was 0.47 (95% CI 0.33–0.67), rising to 0.87 (95% CI 0.70–1.08) by 2001. Subsequent periods showed slight increases, with 2007 having a period rate ratio of 1.23 (95% CI 1.02–1.49) and 2010 a period rate ratio of 1.19 (95% CI 0.93–1.35). The periods from 2013 to 2016 maintained a period rate ratio close to the reference period at 1.09 (95% CI 0.91–1.33). The Wald test confirmed statistically significant differences among period rate ratios (p<0.001).

Fig. 3D displayed the net drift and local drift. The net drift from 1990 to 2017 was 3.8% per year (95% CI 2.9%–4.7%; p<0.001), indicating a significant annual increase in PCa incidence. Local drifts showed annual percent changes across different age groups, such as a 5.1% (95% CI 2.9%–7.3%) increase at age 52 years and a 4.5% (95% CI 3.2%–5.7%) increase at age 58 years. The Wald test for local drifts was 0.27, suggesting no significant difference between local drifts and net drift.

3.3. The incidence and mortality of PCa in 12 health districts and Bangkok in Thailand

3.3.1. Incidence rates

Trends over time in CIRs of PCa across 12 health districts and Bangkok in Thailand from 2012 to 2020 revealed notable variability in CIRs. Several health districts demonstrated fluctuating incidence rates, with district patterns observed across the country. Districts 2 and 5 showed a general increase in CIRs, indicating a rise in new cases, while District 8 peaked around 2019 before declining. Bangkok exhibited a peak around the 2017–2018 period, followed by a significant decline towards 2020; the decrease in CIRs in the later years may also reflect the impact of the coronavirus disease 2019 (COVID-19) pandemic, leading to underreporting of new cases (Fig. 4).

Figure 4.

Trends over time in CIRs for 12 health districts and Bangkok in Thailand. (A) Twelve health districts; (B) Bangkok. CIR, crude incidence rate.

The joinpoint regression analysis from 2012 to 2020 highlighted significant trends across the districts. District 1 had a strong overall AAPC of 16%; District 2 had an AAPC of 7.0%; District 3 had a slight overall decrease with an AAPC of −6.4%. Districts 4, 5, and 6 had moderate increases, while Districts 7, 8, and 9 showed substantial growth with AAPCs of 6.0%, 13%, and 8.3%, respectively. District 10 experienced fluctuations resulting in an AAPC of 2.3%; District 11 had an AAPC of 7.6%; District 12 had a significant overall increase with an AAPC of 11%. Bangkok's trend showed an AAPC of 1.8%, reflecting an initial rise followed by a decline. More details are provided in Table 1.

Table 1.

Overall trend in incidence (2012–2020): the AAPC across 12 health districts and Bangkok.

Health district	AAPC, %	95% CI, %
1	16a	12–20
2	7.0	−5.3–20
3	−6.4	−12–0.04
4	2.4	−1.9–7.2
5	5.7	−0.64–13
6	1.3	−2.6–5.4
7	6.0a	0.31–13
8	13a	7.0–20
9	8.3a	5.7–11
10	2.3	−3.4–10
11	7.6a	1.9–15
12	11a	4.4–22
Bangkok	1.8	−3.6–8.9

AAPC, average annual percent change; CI, confidence interval.

^ap<0.05 indicates that the AAPC is significantly different from zero using joinpoint regression with the Monte Carlo permutation test.

3.3.2. MRs

The analysis of PCa MRs across 12 health districts and Bangkok in Thailand from 2012 to 2020 showed varied and district-specific trends (Fig. 5). Most districts experienced fluctuations, with several showing an increasing trend towards the end of the study period. District 1 gradually increased, peaking around 2018. District 2 consistently rose from 2015 onwards, while District 3 peaked around the 2015–2016 period. Districts 4, 5, and 6 showed significant increases, especially from 2017. Districts 7, 8, and 9 exhibited general upward trends, with notable peaks around the 2017–2018 period. District 10 had fluctuations with an overall rise, while Districts 11 and 12 showed increases towards the end of the period. Bangkok's MRs peaked around 2019 with a slight decline by 2020.

Figure 5.

Trends over time in mortality rates for 12 health districts and Bangkok. (A) Twelve health districts; (B) Bangkok.

The joinpoint regression analysis confirmed these trends, highlighting consistent increases in Districts 1, 2, and 5, with District 2 showing the highest AAPC of 10% (95% CI 6.1%–15%). Districts 6 and 7 saw significant rises with AAPCs of 7.5% (95% CI 2.6%–13%) and 9.0% (95% CI 3.7%–16%), respectively, while District 8 had an AAPC of 11% (95% CI 9.3%–13%). District 12 experienced the highest overall increase, with an AAPC of 13% (95% CI 2.1%–30%). Bangkok's MR fluctuated and also increased significantly, with an AAPC of 6.2% (95% CI 0.67%–12%) (Table 2).

Table 2.

The AAPC in mortality among 12 health districts and Bangkok from 2012 to 2020.

Health district	AAPC, %	95% CI, %
1	6.1a	0.79–12
2	10a	6.1–15
3	4.1	−0.74–9.3
4	6.8a	0.81–14
5	8.4a	4.9–13
6	7.5a	2.6–13
7	9.0a	3.7–16
8	11a	9.3–13
9	7.9a	5.1–11
10	5.8a	4.1–8.1
11	8.7a	6.3–12
12	13a	2.1–30
Bangkok	6.2a	0.67–12

AAPC, average annual percent change; CI, confidence interval.

^ap<0.05 indicates that the AAPC is significantly different from zero using joinpoint regression with the Monte Carlo permutation test.

3.4. Comparison of the incidence and mortality trends of PCa

When we compared the incidence and mortality trends of PCa across Thailand from 2012 to 2019, several patterns emerged. Districts with significant increases in incidence rates, such as Districts 1, 7, 8, 9, and 12, also exhibited rising mortality trends. For instance, District 1 showed a high EAPC of 28% in the incidence rate from 2012 to 2015 and a significant increase in MR peaking around 2018. Similarly, District 8 experienced a substantial increase in incidence with an EAPC of 12.6% from 2012 to 2019, accompanied by notable rises in MR starting from 2015, with an EAPC of 11% from 2012 to 2019.

District 7 also showed a significant EAPC in the incidence rate of 6.0% from 2012 to 2019, continuing to rise thereafter, resulting in an EAPC in mortality of 9.0% from 2012 to 2019. District 9 demonstrated consistent growth in the incidence rate, with a significant EAPC of 8.3% from 2012 to 2019. The mortality in this district steadily increased with an EAPC of 7.9%. District 12 showed the highest overall increase in the incidence rate, with an initial EAPC of 42% from 2012 to 2015, followed by a decline, leading to a significant rise in MR with an EAPC of 13% from 2012 to 2019.

However, some districts exhibited opposite trends, where the increase in the incidence rate was not in parallel with the increase in mortality. For example, District 3 showed discordant trends: incidence rose slightly in 2012–2017 (EAPC 2.5%) but declined significantly in 2017–2019 (EAPC −26%), whereas mortality increased significantly in 2012–2015 (EAPC 19%) and then declined non-significantly in 2015–2019 (EAPC −5.8%). Details of incidence rates and MRs are in the Supplementary Tables 2 and 3.

3.5. Projections

Fig. 6 illustrated the projected trend in the ASR of PCa in Thailand up to 2040, based on the joinpoint regression analysis. The projections indicated that the ASR of PCa in Thailand would continue to rise significantly by 2040 (p<0.05). For the specific cohort of males aged 50 years and older, the ASR was expected to increase from 8.3 (95% PI 6.3–10.3) cases per 100 000 person-years in 2018 to 15.4 (95% PI 11.6–19.1) cases per 100 000 person-years by 2040, representing a 1.91-fold increase.

Figure 6.

Prostate cancer incidence trend projections to 2040 in males aged 50 years and older.

4. Discussion

PCa is the fourth most common cancer among Thai men [18]. This study is the first to report the national incidence and MRs of PCa in Thailand from 1990 to 2017. The findings show a significant increase in the PCa ASR, more than doubling from 3.84 to 7.72 cases per 100 000 person-years, with an EAPC of 2.7%. This increase correlates with the global trend, indicating factors such as aging populations, improved diagnostics, and lifestyle changes contribute to the rising incidence [3,4,19].

Among 5-year age groups, the highest age-specific incidence rate was observed in the 70–74 age group, while the open-ended ≥75 age group showed even higher rates (Fig. 2), consistent with the established association between age and PCa risk [20]. The projection suggests that by 2040, the ASR for males aged 50 years and older will rise to 15.4 cases per 100 000 person-years, indicating the need for targeted PCa screening and interventions. While this projection assumes current trends will continue, evolving factors like PSA screening practices, healthcare access, and public health interventions promoting healthier lifestyles could significantly influence future trends. However, due to data limitations, the current projection focuses on stable factors like population aging and the current lifestyle patterns, which are unlikely to change drastically in the short term.

The regional analysis from 2012 to 2020 showed variability across health districts. Districts 2 (Northern) and 5 (Eastern) exhibited increases in CIRs, while District 8 (Northeastern) peaked around 2019 and then declined. Bangkok displayed a peak in 2017–2018, likely due to under-reporting during the COVID-19 pandemic. Several districts showed significant increases in both the incidence rates and MRs, emphasizing the need for improved cancer management in these specific regions.

Economic disparities and healthcare equity are key factors influencing PCa incidence in Thailand. Urban areas, such as Bangkok, benefit from better healthcare infrastructure and access to PSA screening, leading to earlier detection and higher diagnosis rates. In contrast, PSA screening is not yet covered by Thailand's Universal Health Coverage scheme, leading to lower detection rates in rural areas where screening is not freely available [18]. An updated economic evaluation of PSA screening in Thailand is needed to reflect recent evidence and improve cost-effectiveness assessments [21]. Additionally, Thailand's aging population, with individuals over 60 years old accounting for 10% of the population, along with socioeconomic development and shifts toward Westernized diets and sedentary lifestyles, contributes to an increased PCa risk [22,23].

When compared with other countries in Southeast Asia, PCa incidence and MRs in Thailand have historically been lower than those in Western countries, but recent trends indicate a rapid increase in both the incidence rates and MRs due to the aging population [24]. Epidemiology and genomics of PCa in Asian men indicate that the PCa incidence rates and MRs in Asia have been rapidly increasing, with substantial regional variation observed among different regions. Mortality decreased in Japan and Israel but increased in Thailand, Kyrgyzstan, and Uzbekistan from 2007 to 2016 [24]. Genetic polymorphisms are also a key factor in the prevalence of PCa. The genomic analyses revealed that differences in the prevalence of the E26 transformation-specific-related gene oncoprotein, phosphatase and tensin homolog loss, chromodomain helicase DNA binding protein 1 enrichment, and forkhead box protein A1 alterations in Asian populations may affect the diversity in genetic characteristics of PCa across Asia [24].

In Thailand, data from the Songkhla Cancer Registry, covering 1990 to 2013, showed that 855 cases of PCa were diagnosed in Songkhla province in the southern part of Thailand. The study also indicated that the MR of PCa in Thailand was relatively high and increased at an EAPC of 5.3%, and that the projections of incidence and mortality would continue to rise through 2030 [25]. The prevalence of PCa in the northeastern region of Thailand was estimated to be 6.2% among patients aged 45 years and older in a study conducted at Srinagarind Hospital [26]. The incidence rate of PCa in Thailand is also influenced by socioeconomic factors, with individuals with lower socioeconomic status experiencing higher exposure to risk factors and lower healthcare accessibility, often resulting in late-stage diagnosis [18]. The MR increased significantly, with a notable rise in deaths from PCa in Thailand between 2007 and 2016 [24].

Socioeconomic development has widened the gap in healthcare access, with urban populations benefiting from better facilities, while rural populations, particularly in northeastern and northern regions with household incomes lower than the national average, are at greater risk of PCa [27]. This is reflected in higher prevalence and MRs in these regions. Limited healthcare access in less urbanized regions contributes to under-reporting and later-stage diagnoses, though improved services are expected to increase detection rates [28]. Over time, factors like screening practices and public health initiatives could alter the incidence trend. Future studies should address these changing factors to refine projections and healthcare strategies. Moreover, to tackle economic disparities, efforts to expand Universal Health Coverage to include PSA screening and enhance healthcare services in underserved regions are critical for managing the increasing burden of PCa.

4.1. Study limitations

The accuracy of the cancer registry data depends on the completeness and reliability of reporting, as inconsistencies in data collection methods across different regions and time periods could impact the findings. Due to incomplete data, the study was unable to monitor the national MRs. Future research should focus on enhancing data collection and validation to ensure the completeness of reports; particularly in the later years of the study, data may be influenced by external factors such as the COVID-19 pandemic, potentially leading to under-reporting or misclassification of deaths. Analysis limitations include potential biases from data aggregation methods, which may mask variations within smaller subpopulations or regions. The lack of individual-level data prevents a more nuanced analysis of risk factors and outcomes.

Additionally, this study assumed stable factors in population aging and lifestyle patterns, but evolving factors such as healthcare access or updated screening guidelines could have a significant impact on future trends. Future studies with more detailed regional data and scenario-based models will be essential to refine projections as more information becomes available. While this study provides a foundation, future research should account for dynamic changes in healthcare and lifestyle that could influence the PCa trend in Thailand.

Variations in diagnostic criteria of PCa in Thailand are also a major limitation due to the lack of a standardized PSA cut-off value for Thai men. Studies have shown that the PSA reference ranges in Thai men are lower than in Western populations, suggesting using Western cut-off values could lead to unnecessary biopsies and misdiagnoses [29,30]. Moreover, the specificity of PSA as a diagnostic tool is relatively low, with studies indicating that a PSA cut-off level of 4 ng/mL has only 40% specificity, which complicates the accuracy of prevalence estimates [26].

4.2. Policy implications

The study shows that PCa is a growing public health issue in Thailand. Healthcare policymakers must take immediate action in light of the considerable rise in the incidence and MRs over the previous few decades, as well as projections indicating future increases. To address this growing burden, it is imperative to implement efficient cancer control strategies, and improve early detection programmes and treatment accessibility.

The Thailand NCCP includes PCa screening as a critical component. Screening programs primarily focus on high-risk groups, such as men over 50 years old and those with a family history of PCa. The Ministry of Public Health has implemented initiatives to increase awareness and encourage participation in screening programs. Efforts are also underway to improve the accessibility and affordability of screening services, particularly in rural and underserved areas [11].

5. Conclusion

The PCa incidence rates and MRs in Thailand have risen significantly, mirroring trends in other parts of the world. The aging population and advancements in diagnostic techniques are likely contributors to these increases. Continuous monitoring of the cancer trend, along with robust public health initiatives, is essential to mitigate the impact of PCa on the Thai population in the coming decades.

Conflicts of interest

The author declares no conflict of interest.

Appendix A. Supplementary data

The following is the Supplementary data to this article: