Secular trends in prostate cancer mortality, incidence and treatment: England and Wales, 1975-2004

OBJECTIVE To aid the interpretation of the trends in prostate cancer mortality, which declined in the UK in the early 1990s for unknown reasons, by investigating prostate cancer death rates, incidence and treatments in England and Wales in 1975-2004. METHODS Join-point regression was used to assess secular trends in mortality and incidence (source: Office of National Statistics), radical prostatectomy and orchidectomy (source: Hospital Episode Statistics database) and androgen-suppression drugs (source: Intercontinental Medical Statistics). RESULTS Prostate cancer mortality declined from 1992 (95% confidence interval, CI, 1990-94). The relative decline in mortality to 2004 was greater and more sustained amongst men aged 55-74 years (annual percentage mortality reduction 2.75%; 95% CI 2.33-3.18%) than amongst those aged >= 75 years (0.71%, 0.26-1.15%). The use of radical prostatectomy increased between 1991 (89 operations) and 2004 (2788) amongst men aged 55-74 years. The prescribing of androgen suppression increased between 1987 (33 000 prescriptions) and 2004 (470 000). CONCLUSIONS The decrease in prostate cancer mortality was greater amongst men aged 55-74 years than in those aged >= 75 years, but pre-dated the substantial use of prostate-specific antigen screening and radical prostatectomy in the UK. An increase in radical therapy amongst younger groups with localized cancers and screen-detected low-volume locally advanced disease as a result of stage migration, as well as prolonged survival from increased medical androgen suppression therapy, might partly explain recent trends.