Prostate cancer – incidence and mortality

• Prostate cancer is the most common cancer among men in the ACT. In 2019, there were 362 new cases of prostate cancer diagnosed in ACT men. The 2019 age-standardised incidence rate in the ACT was 174.2 cases per 100,000 males, compared to 124.8 per 100,000 males for Australia in 2019.^1,2 However, it is important to remember that the 2019 Australian incidence data is based on estimates only, and prostate cancer incidence rates have fluctuated dramatically over time, largely driven by changes in diagnostic procedures and the uptake of Prostate Specific Antigen (PSA) testing. According to the Australian Institute of Health and Welfare (AIHW), the “fluctuating nature of prostate incidence over the past 26 years makes it difficult to project into the future with any degree of certainty”.³
• In 2018, 40 men who lived in the ACT at the time of their prostate cancer diagnosis died from prostate cancer. In 2018 the age-standardised mortality rate for the ACT was 21.8 deaths per 100,000 males, compared to 23.8 deaths per 100,000 males for Australia in 2018.^1,2
• One of the major risk factors for prostate cancer is older age, so the number of men in the ACT with prostate cancer is likely to increase as our population increases and the proportion of older men in the population grows.
• An increase in the incidence of prostate cancer was seen in the ACT after Prostate Specific Antigen (PSA) testing was introduced in the late 1980s, but the incidence rate is now lower than that of 20 years ago.
• Five-year survival from prostate cancer has improved over time, from 71.9% in the period 1988–1997 to 96.9% for the period 2008–2017. There were no significant differences in survival for males with prostate cancer under the age of 65 and those aged 65 and over.1-8 The dramatic improvement in prostate cancer survival over time most likely reflects both earlier diagnosis and the effect of better treatment.
• However, there is also evidence that a substantial proportion of prostate cancers which are diagnosed and treated would not have manifested clinically during a patient's lifetime, nor resulted in cancer-related death. This partly reflects the widespread use of PSA testing in men without any symptoms of prostate cancer. Such overdiagnosis and overtreatment contribute to patient anxiety and unnecessary sequelae of treatment, including urinary, bowel and erectile dysfunction, as well as placing additional pressure on health services. ^9-11

*The national 2019 cancer incidence data reported by the Australian Institute of Health and Welfare are estimates based on previous years’ trends. By contrast, all ACT-specific incidence data reported here utilise actual ACT data.

References

1. Australian Institute of Health and Welfare (AIHW). Cancer in Australia 2021. Canberra: AIHW; 2021 [cited 2022 Apr 6]. Available from: https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2021/data.

2. ACT Cancer Registry. Canberra: ACT Cancer Registry; 2022 (unpublished data).

3. AIHW. Cancer Incidence Projections: Australia, 2011 to 2020. Cancer Series no. 66. Cat. No. CAN 62. Canberra: AIHW; 2012. [cited 2022 Jun 10]. Available from: https://www.aihw.gov.au/getmedia/a79de4a1-49f5-4c93-bc59-4d181430aa69/14096.pdf.aspx?inline=true.

4. Australian Bureau of Statistics (ABS). Life Tables, States, Territories and Australia, 2015-2017. Canberra: ABS; 2019 [cited 2022 Apr 6]. Available from: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3302.0.55.001Main+Features12015-2017?OpenDocument=.

5. ABS. Life Tables, States, Territories and Australia, 2014-2016. Canberra: ABS; 2018 [cited 2022 Apr 6]. Available from: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3302.0.55.001Main+Features12014-2016?OpenDocument=.

6. ABS. Life Tables, States, Territories and Australia, 2013-2015. Canberra: ABS; 2017 [cited 2022 Apr 6]. Available from: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3302.0.55.001Main+Features12013-2015?OpenDocument=.

7. ABS. Life Tables, States, Territories and Australia, 2012-2014. Canberra: ABS; 2016 [cited 2022 Apr 6]. Available from: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3302.0.55.001Main+Features12012-2014?OpenDocument=.

8. ABS. Life Tables, States, Territories and Australia, 2011-2013. Canberra: ABS; 2015 [cited 2022 Apr 6]. Available from: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3302.0.55.001Main+Features12011-2013?OpenDocument=.

9. Loeb S, Bjurlin MA, Nicholson J, et al. Overdiagnosis and overtreatment of prostate cancer. Eur Urol 2014; 65(6): 1046-1055.

10. Pathirana T, Hayen A, Doust J, et al. Lifetime risk of prostate cancer overdiagnosis in Australia: quantifying the risk of overdiagnosis associated with prostate cancer screening in Australia using a novel lifetime risk approach. BMJ Open. 2019; 9(3):e022457.

11. Fenton JJ, Weyrich MS, Durbin S, et al. Prostate-Specific Antigen–Based Screening for Prostate Cancer: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018; 319(18):1914–1931.

The authors wish to thank the Registries of Births, Deaths and Marriages, the Coroners and the National Coronial Information System for enabling the cause of death unit record file data to be used for this publication.