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CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1993 Sep 1;149(5):617–624.

Prostate cancer trends in Canada: rising incidence or increased detection?

I G Levy 1, L Gibbons 1, J P Collins 1, D G Perkins 1, Y Mao 1
PMCID: PMC1486022  PMID: 8364818

Abstract

OBJECTIVES: To analyse trends in the incidence and mortality rates of prostate cancer in Canada according to age distribution, temporal pattern and provincial variation; to determine any association with the rate of prostatectomy; and to determine whether any observed increase in the rate of prostate cancer was due to an increase in the detection rate. DESIGN: Descriptive epidemiologic study based on Canadian population data from 1959 to 1989 and chart review from one Canadian hospital. SETTING: The chart review was conducted at the Ottawa Civic Hospital. SUBJECTS: The data on prostate cancer trends were obtained from the Canadian population. Charts were reviewed for two groups of patients: (a) men discharged from inpatient care during 1976 and 1986-87 with prostate cancer first diagnosed in the same year and (b) men who underwent transurethral resection of the prostate (TURP) during 1976 and 1986. OUTCOME MEASURES: Incidence and mortality rates of prostate cancer, rates of prostatectomy and TURP, and correlations between them. From the hospital data, changes between 1976 and 1986-87 in distribution of cancer stages, distribution of cases detected incidentally after surgery for suspected benign prostatic hypertrophy and average number of slides analysed per gram of tissue obtained from prostatectomy. RESULTS: The epidemiologic data showed that the age-adjusted incidence rates increased by 72% overall, an increase seen in all age groups over 60 years. The mortality rates increased by 29% overall, primarily in men over 85 years old. The prostatectomy rate increased by 55%. There were significant linear correlations between the national and provincial incidence rates of prostate cancer and the TURP rates. The chart review revealed that during 1976, 53% of the cases of prostate cancer diagnosed were localized, as compared with 75% in 1986-87 (p < 0.01). The proportion of tumours diagnosed incidentally in men undergoing TURP increased by 11%, whereas the number of procedures did not increase. Significantly more slides per gram of tissue were analysed in 1986-87 than in 1976 (p < 0.01). CONCLUSIONS: The correlations between the incidence rates of prostate cancer and those of TURP suggest that increased treatment of benign prostatic disease has led to increased detection of prostate cancer. Extrapolation of the data obtained from the chart review indicates that the increase in observed incidence rates can be attributed to an increase in the rate of localized disease and thus primarily to early detection rather than to elevated risk. However, because the rate of death from prostate cancer was elevated in elderly men, increases in exposure to unestablished risk factors cannot be ruled out.

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Selected References

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  1. Armstrong B., Doll R. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer. 1975 Apr 15;15(4):617–631. doi: 10.1002/ijc.2910150411. [DOI] [PubMed] [Google Scholar]
  2. Ayiomamitis A. Epidemiology of cancer of the prostate in Canada: 1950-1984. Br J Urol. 1987 Aug;60(2):157–161. doi: 10.1111/j.1464-410x.1987.tb04954.x. [DOI] [PubMed] [Google Scholar]
  3. Carter H. B., Coffey D. S. The prostate: an increasing medical problem. Prostate. 1990;16(1):39–48. doi: 10.1002/pros.2990160105. [DOI] [PubMed] [Google Scholar]
  4. Dhom G. Epidemiologic aspects of latent and clinically manifest carcinoma of the prostate. J Cancer Res Clin Oncol. 1983;106(3):210–218. doi: 10.1007/BF00402610. [DOI] [PubMed] [Google Scholar]
  5. Donn A. S., Muir C. S. Prostatic cancer: some epidemiological features. Bull Cancer. 1985;72(5):381–390. [PubMed] [Google Scholar]
  6. Elghany N. A., Schumacher M. C., Slattery M. L., West D. W., Lee J. S. Occupation, cadmium exposure, and prostate cancer. Epidemiology. 1990 Mar;1(2):107–115. doi: 10.1097/00001648-199003000-00005. [DOI] [PubMed] [Google Scholar]
  7. Fincham S. M., Hill G. B., Hanson J., Wijayasinghe C. Epidemiology of prostatic cancer: a case-control study. Prostate. 1990;17(3):189–206. doi: 10.1002/pros.2990170303. [DOI] [PubMed] [Google Scholar]
  8. Ghadirian P., Cadotte M., Lacroix A., Perret C. Family aggregation of cancer of the prostate in Quebec: the tip of the iceberg. Prostate. 1991;19(1):43–52. doi: 10.1002/pros.2990190105. [DOI] [PubMed] [Google Scholar]
  9. Gittes R. F. Carcinoma of the prostate. N Engl J Med. 1991 Jan 24;324(4):236–245. doi: 10.1056/NEJM199101243240406. [DOI] [PubMed] [Google Scholar]
  10. Graham S., Haughey B., Marshall J., Priore R., Byers T., Rzepka T., Mettlin C., Pontes J. E. Diet in the epidemiology of carcinoma of the prostate gland. J Natl Cancer Inst. 1983 Apr;70(4):687–692. [PubMed] [Google Scholar]
  11. HAENSZEL W. Cancer mortality among the foreign-born in the United States. J Natl Cancer Inst. 1961 Jan;26:37–132. [PubMed] [Google Scholar]
  12. Haenszel W., Kurihara M. Studies of Japanese migrants. I. Mortality from cancer and other diseases among Japanese in the United States. J Natl Cancer Inst. 1968 Jan;40(1):43–68. [PubMed] [Google Scholar]
  13. Heshmat M. Y., Kaul L., Kovi J., Jackson M. A., Jackson A. G., Jones G. W., Edson M., Enterline J. P., Worrell R. G., Perry S. L. Nutrition and prostate cancer: a case-control study. Prostate. 1985;6(1):7–17. doi: 10.1002/pros.2990060103. [DOI] [PubMed] [Google Scholar]
  14. Humphrey P., Vollmer R. T. The ratio of prostate chips with cancer: a new measure of tumor extent and its relationship to grade and prognosis. Hum Pathol. 1988 Apr;19(4):411–418. doi: 10.1016/s0046-8177(88)80490-8. [DOI] [PubMed] [Google Scholar]
  15. Kolonel L. N., Yoshizawa C. N., Hankin J. H. Diet and prostatic cancer: a case-control study in Hawaii. Am J Epidemiol. 1988 May;127(5):999–1012. doi: 10.1093/oxfordjournals.aje.a114903. [DOI] [PubMed] [Google Scholar]
  16. Mao Y., Robson D., Semenciw R. M., Morrison H. I., Wigle D. T. Long-term survival rates among patients with cancer in Saskatchewan, 1967-1986. Can J Public Health. 1991 Nov-Dec;82(6):413–420. [PubMed] [Google Scholar]
  17. Montie J. E., Wood D. P., Jr, Pontes J. E., Boyett J. M., Levin H. S. Adenocarcinoma of the prostate in cystoprostatectomy specimens removed for bladder cancer. Cancer. 1989 Jan 15;63(2):381–385. doi: 10.1002/1097-0142(19890115)63:2<381::aid-cncr2820630230>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  18. Murphy G. P., Natarajan N., Pontes J. E., Schmitz R. L., Smart C. R., Schmidt J. D., Mettlin C. The national survey of prostate cancer in the United States by the American College of Surgeons. J Urol. 1982 May;127(5):928–934. doi: 10.1016/s0022-5347(17)54135-x. [DOI] [PubMed] [Google Scholar]
  19. Murphy G. P. The current and potential status of screening for prostatic cancer in asymptomatic populations. Prog Clin Biol Res. 1989;303:19–25. [PubMed] [Google Scholar]
  20. Potosky A. L., Kessler L., Gridley G., Brown C. C., Horm J. W. Rise in prostatic cancer incidence associated with increased use of transurethral resection. J Natl Cancer Inst. 1990 Oct 17;82(20):1624–1628. doi: 10.1093/jnci/82.20.1624. [DOI] [PubMed] [Google Scholar]
  21. Roos N. P., Wennberg J. E., Malenka D. J., Fisher E. S., McPherson K., Andersen T. F., Cohen M. M., Ramsey E. Mortality and reoperation after open and transurethral resection of the prostate for benign prostatic hyperplasia. N Engl J Med. 1989 Apr 27;320(17):1120–1124. doi: 10.1056/NEJM198904273201705. [DOI] [PubMed] [Google Scholar]
  22. Schmidt J. D., Mettlin C. J., Natarajan N., Peace B. B., Beart R. W., Jr, Winchester D. P., Murphy G. P. Trends in patterns of care for prostatic cancer, 1974-1983: results of surveys by the American College of Surgeons. J Urol. 1986 Aug;136(2):416–421. doi: 10.1016/s0022-5347(17)44889-0. [DOI] [PubMed] [Google Scholar]
  23. Severson R. K. Have transurethral resections contributed to the increasing incidence of prostatic cancer? J Natl Cancer Inst. 1990 Oct 17;82(20):1597–1598. doi: 10.1093/jnci/82.20.1597. [DOI] [PubMed] [Google Scholar]
  24. Spitz M. R., Currier R. D., Fueger J. J., Babaian R. J., Newell G. R. Familial patterns of prostate cancer: a case-control analysis. J Urol. 1991 Nov;146(5):1305–1307. doi: 10.1016/s0022-5347(17)38074-6. [DOI] [PubMed] [Google Scholar]
  25. Staszewski J., Haenszel W. Cancer mortality among the Polish-born in the United States. J Natl Cancer Inst. 1965 Aug;35(2):291–297. [PubMed] [Google Scholar]

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