Changes in Mortality and Incidence of Prostate Cancer by Risk Class in Different Periods in Italy: The Possible Effects of PSA Spread

Author:

Vicentini Massimo12,Sacchettini Claudio12,Trama Annalisa3,Nicolai Nicola4,Gatta Gemma3,Botta Laura3,Valdagni Riccardo56,Giorgi Rossi Paolo12,Pannozzo Fabio7,Contiero Paolo8,Fusco Mario9,Lodde Michele10,Mazzoleni Guido11,Piffer Silvano12,Tumino Rosario13,Puppo Antonella14,Seeber Andreas15,Mangone Lucia16,

Affiliation:

1. Interinstitutional Epidemiology Unit, AUSL Reggio Emilia, Reggio Emilia - Italy

2. Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia - Italy

3. Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy

4. Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy

5. Diagnostic Imaging and Radiotherapy, Università degli Studi di Milano, Milan - Italy

6. Prostate Cancer Program and Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy

7. (Latina Cancer Registry, Italy)

8. (Varese Cancer Registry, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy)

9. (Naples Cancer Registry, Italy)

10. (Urology Unit, Ospedale Centrale di Bolzano, Italy)

11. (Alto Adige Cancer Registry, Provincia di Bolzano, Italy)

12. (Evaluative Epidemiology Unit, Trento Cancer Registry, Italy)

13. (Ragusa Cancer Registry, Italy)

14. (Liguria Cancer Registry, IRCCS AOU San Martino IST Genoa, Italy)

15. (Department for Haematology and Oncology, Tyrolean Cancer Research Institut, Innsbruck Medical University, Austria)

16. (Reggio Emilia Cancer Registry, AUSL Reggio Emilia, and Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy)

Abstract

Purpose In Italy, the spread of prostate-specific antigen (PSA) testing varies in different areas. A peak of incidence was reached in 2003-2004 in some areas, while in others the incidence is still increasing. Mortality has declined since 1999 in some areas, while it remains stable in others. We compared mortality and the risk of advanced cancer over 2 periods (1996-1998; 2005-2007) and by geographic area characterized by a different spread of PSA, to understand the possible impact of PSA on the epidemiology of prostate cancer. Methods In 8 Italian Cancer Registries (CRs), 4,632 cases diagnosed over 2 periods, 1996-1998 and 2005-2007, were sampled to assess risk class. The CRs were classified into late and early phase of PSA testing depending on whether an incidence peak had been reached by 2008. Incidence by risk class was estimated based on overall incidence in each CR and on risk class distribution in the sample. We calculated standardized mortality (MRR) and risk class-specific incidence rate ratios (IRR) to compare the 2 periods. Results Incidence increased from 1996-1998 to 2005-2007 (IRR 1.5; 95% CI 1.4, 1.6). High-risk and metastatic cancer incidence decreased only in late-phase areas (IRR 0.78; 95% CI 0.69, 0.88; and 0.40; 95% CI 0.30, 0.54, respectively), while in early-phase areas, incidence remained virtually stable (IRR 1.2; 95% CI 1.0, 1.4; and 0.77; 95% CI 0.59, 1.0, respectively). Mortality decreased only in late-phase areas (MRR 0.81; 95% CI 0.85, 0.97; vs 1.1; 95% CI 0.92, 1.2) in early-phase areas. Conclusions Mortality reduction and a decrease in high-risk and metastatic cases occurred simultaneously only in areas in late phase of PSA spread.

Publisher

SAGE Publications

Subject

Cancer Research,Oncology,General Medicine

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