International Trends in Prostate-Cancer Mortality: The Decrease is Continuing and Spreading

OBJECTIVE: To measure recent changes in prostate-cancer mortality across 24 developed countries. METHODS: Mortality data for men aged 50-79 years were obtained from the World Health Organisation mortality database and we assessed trends in age-standardised mortality rates using joinpoint regression models. RESULTS: Significant reductions in prostate-cancer mortality were observed in United Kingdom, United States, Austria, Canada, Italy, France, Germany, Australia and Spain, and downward trends were also observable in the Netherlands, Ireland and Sweden. CONCLUSIONS: Mortality declines for prostate cancer are now evident in 12 out of the 24 developed countries considered in this analysis. Increases in PSA screening and better treatment of early-stage disease, possibly acting in combination, remain plausible hypotheses.     

Recent declines in worldwide mortality from cutaneous melanoma in youth and middle age

Trends in age-standardised death-certification rates for skin cancer [mainly cutaneous malignant melanoma (CMM)] over the period 1955-1995 were considered for 22 developed countries (18 from Europe, Canada, the United States, Australia and New Zealand) on the basis of the World Health Organization database. Between 1955 and 1984, mortality from CMM has been rising in both young adults (20 to 44 years) and middle aged population (45 to 64 years) in most European countries, North America and Australia. Between 1985 and 1995, CMM mortality rates were still rising in several countries for middle-aged males, though, to a lesser extent, they were more favourable in middle-aged women and declined in young adults in most countries, particularly in northern Europe.     

Recent trends in prostate cancer mortality show a continuous decrease in several countries

Prostate specific antigen (PSA) screening was introduced to detect prostate cancer at an early stage and to reduce prostate cancer-specific mortality. Until results from clinical trials are available, the efficacy of PSA screening in reducing prostate cancer mortality can be estimated by surveillance of prostate cancer mortality trends. Our study analyzes recent trends in prostate cancer mortality in 38 countries. We used the IARC-WHO cancer mortality database and performed joinpoint analysis to examine prostate cancer mortality trends and identified 3 patterns. In USA, and to a lesser extent in Germany, Switzerland, Canada, France, Italy and Spain, prostate cancer-specific mortality decreased to a level lower than before the introduction of PSA screening. In Australia, New Zealand, Austria, Finland, The Netherlands, Norway, United Kingdom, Hungary, Slovakia, Israel, Singapore, Sweden and Portugal, mortality from prostate cancer decreased but rates remain higher than before the introduction of PSA screening. Prostate cancer mortality continued to increase in Belgium, Denmark, Greece, Ireland, Bulgaria, Czech Republic, Belarus, Ukraine, Russian Federation, Romania, Poland, Argentina, Chile, Cuba, Mexico, Japan, China Hong Kong and the Republic of Korea. The trends in prostate cancer mortality rates in examined countries suggest that PSA screening may be effective in reducing mortality from prostate cancer.     

Cancer mortality in the elderly in 11 countries worldwide, 1970–2015

BackgroundPopulation ageing results in an increasing cancer burden in the elderly. We aimed to evaluate time-trends in cancer mortality for adults aged 65 and over for 17 major cancer types and all cancers combined in 11 countries worldwide over the period 1970–2015.Materials and methodsWe obtained cancer death certification and population figures from the WHO and PAHO databases. We computed age-standardised (world standard population) rates for individuals aged 65 and over, and applied joinpoint regression models.ResultsAge-standardised mortality rates for all cancers combined showed a heterogeneous, but widespread decline. Lung cancer mortality rates have been decreasing among men, and increasing among women. Pancreatic cancer had unfavourable trends in all countries for both sexes. Despite variability across countries, other tobacco-related cancers (except kidney) showed overall favourable trends, except in Poland and Russia. Age-standardised mortality rates from stomach cancer have been declining in all countries for both sexes. Colorectal mortality has been declining, except in Poland and Russia. Liver cancer mortality increased in all countries, except in Japan, France and Italy, which had the highest rates in the past. Breast cancer mortality decreased for most countries, except for Japan, Poland and Russia. Trends for age-standardised uterine cancer rates in the USA, Canada and the UK were increasing over the last decade. Ovarian cancer rates showed declines in most countries. With the exception of Russia, prostate cancer rates showed overall declines. Lymphoid neoplasms rates have been declining in both sexes, except in Poland and Russia.ConclusionOver the last decades, age-standardised cancer mortality in the elderly has been decreasing in major countries worldwide and for major cancer sites, with the major exception of lung and uterine cancer in women and liver, pancreatic and kidney cancers in both sexes. Cancer mortality for the elderly in central and eastern Europe remains comparatively high.     

Trends in UK regional cancer mortality 1991–2007

Background:

Until 1990, there was an upward trend in mortality from breast, lung, prostate, and colon cancers in the United Kingdom. With improvements in cancer treatment there has, in general, been a fall in mortality over the last 20 years. We evaluate regional cancer mortality trends in the United Kingdom between 1991 and 2007.

Methods:

We analysed mortality trends for breast, lung, prostate, and colon cancers using data obtained from the EUREG cancer database. We have described changes in age-standardised rates (using European standard population) per 100 000 for cancer mortality and generated trends in mortality for the 11 regions using Joinpoint regression.

Results:

Across all regions in the United Kingdom there was a downward trend in mortality for the four most common cancers in males and females. Overall, deaths from colon cancer decreased most rapidly and deaths from prostate cancer decreased at the slowest rate. Similar downward trends in mortality were observed across all regions of the United Kingdom with the data for lung cancer exhibiting the greatest variation.

Conclusions:

Mortality from the four most common cancers decreased across all regions of the United Kingdom; however, the rate of decline varied between cancer type and in some instances by region.     

Interpreting trends in prostate cancer incidence and mortality in the five Nordic countries

Trends in incidence and mortality rates of prostate cancer were analyzed using data from the national cancer registries of Denmark, Finland, Iceland, Norway, and Sweden. Joinpoint regression models were used to quantify temporal trends for the period from 1980 to 2004. Incidence rates were increasing and similar in the Nordic countries during the 1980s. Around 1990, a more rapid incidence increase began in all Nordic countries except Denmark, where an increase was seen 5 years later. In 2001, incidence rates in Denmark were half of those seen in the other Nordic countries, but mortality rates varied only marginally among countries. Mean annual declines in prostate cancer mortality of 1.9% (95% CI = 0.4% to 3.3%) and 1.8% (95% CI = 0.5% to 3.0%) were observed from 1996 to 2004 in Finland and Norway, respectively. During the same period, mortality rates leveled off in Iceland and Sweden but continued to increase in Denmark. The rapid increase in incidence during the early 1990s coincided with the introduction of the prostate-specific antigen (PSA) test and conveys little information about the occurrence of potentially lethal disease. Mortality rates, however, have recently stabilized or declined in countries where PSA testing and curative treatment have been commonly practiced since the late 1980s. Although other explanatory factors may be in operation, these trends are consistent with a moderate effect of increased curative treatment of early diagnosed prostate cancer and improved treatment of more advanced disease.     

Breast cancer mortality rates are levelling off or beginning to decline in many western countries: analysis of time trends, age-cohort and age-period models of breast cancer mortality in 20 countries.

Age-standardised mortality rates for breast cancer were examined for 20 countries in Europe, North America, Australia and New Zealand from 1950 to 1992 and age-birth cohort and age-period of death models were fitted to the data. Breast cancer mortality rates generally increased in the earlier decades, but more recently rates have levelled off or begun to decline in most countries. Only in 4 of the 20 countries studied, Belgium, Hungary, Poland and Spain, was there no evidence of a decline or leveling off or mortality in recent birth cohorts or in recent years. In the other countries the decline in mortality appeared to be in part due to birth cohort effects and in part due to period effects. The birth cohort effects were suggestive of a decline in breast cancer rates among women born after about 1920 and were evident in many countries especially Canada, The Netherlands, The United Kingdom and the United States. The decline in mortality in women born after 1920 appeared to be in part related to a reduction in childlessness and a reduction in age at first birth in those generations. As well as the birth cohort effects, there was some evidence of a recent overall decline in mortality rates in several countries, e.g. Austria, FRG, Greece and the UK, and this may be due to an increase in survival resulting from improved management and treatment of women with breast cancer.     

Trends in prostate cancer mortality among black men and white men in the United States

BACKGROUND: Prostate cancer mortality rates in the United States declined sharply after 1991 in white men and declined after 1992 in black men. The current study was conducted to investigate possible mechanisms for the declining prostate cancer mortality rates in the United States. METHODS: The authors examined and compared patterns of prostate cancer incidence, survival rates, and mortality rates among black men and white men in the United States using the 1969-1999 U.S. prostate cancer mortality rates and the 1975-1999 prostate cancer incidence, survival, and incidence-based mortality rates from the Surveillance, Epidemiology, and End Results (SEER) Program for the U.S. population. The SEER data represent approximately 10% of the U.S. population. RESULTS: Prostate cancer incidence and mortality rates showed transient increases after 1986, when the U.S. Food and Drug Administration approved the use of prostate specific antigen (PSA) testing. The age-adjusted prostate cancer mortality rates for men age 50-84 years, however, have dropped below the rate in 1986 since 1995 for white men and since 1997 for black men. In fact, for white men ages 50-79 years, the 1998 and 1999 rates were the lowest observed since 1950. Incidence-based mortality rates by disease stage revealed that the recent declines were due to declines in distant disease mortality. Moreover, the decrease in distant disease mortality was due to a decline in distant disease incidence, and not to improved survival of patients with distant disease. CONCLUSIONS: Similar incidence, survival, and mortality rate patterns are seen in black men and white men in the United States, although with differences in the timing and magnitude of recent rate decreases. Increased detection of prostate cancer before it becomes metastatic, possibly reflecting increased use of PSA testing after 1986, may explain much of the recent mortality decrease in both white men and black men.     

Geographic patterns of prostate cancer mortality and variations in access to medical care in the United States.

BACKGROUND: Striking geographic variation in prostate cancer death rates have been observed in the United States since at least the 1950s; reasons for these variations are unknown. Here we examine the association between geographic variations in prostate cancer mortality and regional variations in access to medical care, as reflected by the incidence of late-stage disease, prostate-specific antigen (PSA) utilization, and residence in rural counties. METHODS: We analyzed mortality data from the National Center for Health Statistics, 1996 to 2000, and incidence data from 30 population-based central cancer registries from the North American Association of Central Cancer Registries, 1995 to 2000. Ecological data on the rate of PSA screening by registry area were obtained from the 2001 Behavioral Risk Factor Surveillance System. Counties were grouped into metro and nonmetro areas according to Beale codes from the Department of Agriculture. Pearson correlation analyses were used to examine associations. RESULTS: Significant correlations were observed between the incidence of late-stage prostate cancer and death rates for Whites (r = 0.38, P = 0.04) and Blacks (r = 0.53, P = 0.03). The variation in late-stage disease corresponded to about 14% of the variation in prostate cancer death rates in White men and 28% in Black men. PSA screening rate was positively associated with total prostate cancer incidence (r = 0.42, P = 0.02) but inversely associated with the incidence of late-stage disease (r = -0.58, P = 0.009) among White men. Nonmetro counties generally had higher death rates and incidence of late-stage disease and lower prevalence of PSA screening (53%) than metro areas (58%), despite lower overall incidence rates. CONCLUSION: These ecological data suggest that 10% to 30% of the geographic variation in mortality rates may relate to variations in access to medical care.     

Partitioning linear trends in age-adjusted rates

Objective: Surveillance of chronic diseases includes monitoring trends in age-adjusted rates in the general population. Statistics that are calculated to describe and compare trends include the annual percent change and the percent change for a specified time period. However, it is also of interest to determine the contribution specific diseases make to an overall trend in order to better understand the impact of interventions and changes in the prevalence of risk factors. The objective here is to provide a method for partitioning a linear trend in age-adjusted rates into disease-specific components.Methods: The method presented is based on linear regression. The decreasing trend in age-adjusted cancer mortality rates for the total United States during the period 1991–96 is analyzed to illustrate the method.Results: Trends in mortality for cancers of the colon/rectum, breast, lung/bronchus, and prostate are found to be responsible for 75% of the decreasing trend in cancer mortality.Conclusions: It is possible to partition an overall trend in age-adjusted rates under the assumption that it and the trends for all mutually exclusive and exhaustive subgroups of interest are linear.     

Trends and patterns in prostate cancer mortality in Belgrade, Serbia: a join-point analysis.

The objective of this analysis was to examine recent changes in prostate cancer mortality among the male population of Belgrade, Serbia, during the period 1975-2002. Mortality data (official death certificates) for prostate cancer were gathered from published and unpublished material of the Municipal Institute of Statistics in Belgrade. Mortality rates were standardized according to the European standard population. Trends in mortality rates were assessed using join-point analysis. During the period from 1975 to 2002 in the population of Belgrade the average age-adjusted mortality rate from prostate cancer during this period was 17.5/100,000 (95% confidence interval, 15.4-19.6), ranging from 8.2/100,000 in 1984 to 31.2/100,000 in 2002. Since 1986 mortality rates among men aged 50 years and over have risen by nearly 6% per year, with the increases being slightly higher among older men (70 years and over 8% per year) compared to younger men (50-69 years, 4% per year). Mortality due to prostate cancer is rising quickly among men in Belgrade. This level of increase is the highest of any reported increase internationally and contrasts sharply with the widespread decrease in prostate cancer mortality in many developed countries.     

International trends and patterns of prostate cancer incidence and mortality

Prostate cancer is the most commonly diagnosed cancer in western men, and incidence is rising rapidly in most countries, including low-risk populations. Age-adjusted incidence and mortality rates from 15 and 13 countries between 1973-77 and 1988-92, respectively, were compared to provide leads for future analytic studies. Large increases in both incidence and mortality rates of prostate cancer were seen for all countries. For incidence, increases were more pronounced in the United States, Canada, Australia, France and the Asian countries, while the increases in medium-risk countries were moderate. Increases in incidence ranged from 25%-114%, 24%-55% and 15%-104% in high-, medium- and low-risk countries, respectively. Mortality rates rose more rapidly in Asian countries than in high-risk countries. Substantial differences in incidence and mortality across countries were evident, with U.S. blacks having rates that were 50-60 times higher than the rates in Shanghai, China. Increasing incidence rates in the United States and Canada are likely to be due in part to the widespread use of transurethral resection of the prostate and prostate-specific antigen testing, while increases in the Asian countries are probably related to westernization in these low-risk populations. The large disparities in incidence between high- and low-risk countries may be due to a combination of genetic and environmental factors. Future studies are needed to examine gene-gene and gene-environment interactions in various countries concurrently to shed light on the etiology of prostate cancer and to help elucidate reasons for the large differences in risk between populations.     

A comparative population-based study of prostate cancer incidence and mortality rates in Singapore, Sweden and Geneva, Switzerland from 1968 to 2006

ABSTRACT: BACKGROUND: Prostate cancer is the most commonly diagnosed malignancy in men in Sweden and Geneva, and the third most common in men in Singapore. This population-based study describes trends in the incidence and mortality rates of prostate cancer in Singapore, Sweden and Geneva (Switzerland) from 1973 to 2006 and explores possible explanations for these different trends. METHODS: Data from patients diagnosed with prostate cancer were extracted from national cancer registries in Singapore (n?=?5,172), Sweden (n?=?188,783) and Geneva (n?=?5,755) from 1973 to 2006. Trends of incidence and mortality were reported using the Poisson and negative binomial regression models. The age, period and birth-cohort were tested as predictors of incidence and mortality rates of prostate cancer. RESULTS: Incidence rates of prostate cancer increased over all time periods for all three populations. Based on the age-period-cohort analysis, older age and later period of diagnosis were associated with a higher incidence of prostate cancer, whereas older age and earlier period were associated with higher mortality rates for prostate cancer in all three countries. CONCLUSIONS: This study demonstrated an overall increase in incidence rates and decrease in mortality rates in Singapore, Sweden and Geneva. Both incidence and mortality rates were much lower in Singapore. The period effect is a stronger predictor of incidence and mortality of prostate cancer than the birth-cohort effect.     

Recent trends in mortality from prostate cancer in male populations of Australia and England and Wales.

Mortality rates from cancer of the prostate in successive periods from 1908 to 1978 in Australia, and 1911 to 1977 in England and Wales, have been examined for trends with time and birth cohort. Age-specific rates and a proportional hazards model, designed to isolate the effect of birth cohort from those of calendar year and age, were used in the analysis. During the period of study, age-standardized mortality rose more than 5-fold in Australian men compared to just over 3-fold in men in England and Wales. In both countries the increases occurred almost entirely before 1960, with relative stability in age-standardized rates since then. The trends in mortality with year of birth were similar in the two sets of data. The risk of death from prostate cancer increased with successive birth cohorts to reach a peak in men born around 1865-1880 in Australia and men born around 1876-1896 in England and Wales. Males born later experienced a continuing reduction in rates, with the exception of age groups between 50 and 69 in which a further increase has appeared, starting with cohorts born after 1910. On the basis of current knowledge of the aetiology of prostate cancer, possible relationships between changes in sexual practices and prostate-cancer risk in successive generations have been explored. It is suggested that lowered sexual activity during the Great Depression may account for the recent cohort-based increases in mortality in middle-aged men.     

Lung cancer mortality in European regions (1955-1997).

BACKGROUND: The different spread of tobacco smoking across European countries has caused a substantial variability in lung cancer mortality. The objective of this investigation was to analyse the trends in lung cancer mortality rates in three broad European regions (Northern and Western countries, Eastern countries, and Mediterranean countries) during the second half of the 20th century. PATIENTS AND METHODS: Mortality data were obtained from the World Health Organisation database. Lung cancer mortality rates were age-standardised by the direct method to the world standard population. Trends from 1955 to 1997 were assessed by means of joinpoint regression analysis. RESULTS: In men, rates in Eastern Europe increased to reach in the 1990s the highest values ever registered, while downward trends were observed in Northern and Western Europe since 1979, and in Mediterranean countries since the 1990s. In women, upward trends were observed in the three regions considered for the whole period. CONCLUSIONS: Different smoking prevalences over time explain the shift of almost one decade in the trends in Mediterranean men as compared with Northern and other Western European men. The persisting upward trends in women in the three regions are of concern.     

Converging patterns of colorectal cancer mortality in Europe

Trends in mortality rates from colorectal cancer during the second half of the 20th century were analysed for 21 European countries and grouped in three broad European regions. For each gender, age-standardised (world standard population) mortality rates were computed by the direct method, and joinpoint analysis was used to identify significant changes in rates. A favourable pattern in colorectal cancer mortality for both genders was observed in most European countries from the 1990s onwards. Colorectal cancer mortality rates were still in the upward direction in some Eastern European countries, as well as in some Mediterranean countries. Mortality rates tended to converge at around 20/100000 in men and around 11/100000 in women. This converging pattern is even clearer when colorectal mortality rates are examined in three broad European regions. Similar mortality rates over recent calendar years have been reached by countries where mortality has been decreasing in recent decades and in those countries (mainly Eastern European and Mediterranean countries) which have experienced a recent levelling-off and decrease. If recent trends are maintained, colorectal cancer mortality is likely to decline further in Europe in the current decade.     

Changing demography of prostate cancer in Asia

There has been a recent trend in Asia towards increasing incidence of prostate cancer, with some low-risk regions, such as Japan and Singapore, reporting a more rapid increase than high-risk countries. In this study, age-specific and age-standardised (world) incidence rates and mortality rates for prostate cancer in Asian countries for 1978-1997 were retrieved and compared. The results confirm that the incidence of prostate cancer has risen by 5-118% in the indexed Asian countries. Incidence at centres in Japan rose as much as 102% (Miyagi 6.3-12.7 per 100,000 person-years) whilst the incidence in Singaporean Chinese increased 118% from 6.6 to 14.4 per 100,000 person-years. The lowest incidence rate recorded was in Shanghai, China and the highest rates were in Rizal Province in the Philippines, although still much lower than those in the United States of America (USA) and many European countries. Whilst the absolute value of the increase is not comparable to North American and European populations, the incidence ratio in many Asian centres is similar to that of the high-risk countries. The mortality data for prostate cancer showed a similar rising trend. The increases in age-adjusted mortality rates per 100,000 person-years, adjusted to the world standard, ranged from 50% in Thailand to 260% in Korea. The difference may be partly due to genetic polymorphism in the androgen receptor and androgen metabolism pathway enzymes as well as to dietary or environmental factors. In particular, phytochemicals, such as isoflavonoids and tea polyphenols, which are common in Asian diets showed promising anti-mitotic activity in animal and clinical studies. In conclusion, with gradual Westernisation, many Asian countries may be losing their cultural protective factors and acquiring high-risk ones. A better understanding of how these factors interact to cause prostate cancer through further studies with a multi-ethnic perspective will facilitate appropriate public health strategies to minimise high-risk factors and maintain protective factors and keep prostate cancer at bay.     

Global trends in oral and pharyngeal cancer incidence and mortality

To provide an up-to-date overview of recent trends in mortality from oral and pharyngeal cancer, we analyzed death certification data for 61 countries worldwide provided by the World Health Organization in 2010–2015, and, for selected most populous countries, over the period 1970–2016. For 12 largest countries, we analyzed incidence derived from Cancer Incidence in Five Continents in 1960–2012 for all oral and pharyngeal cancers and by subsites. In 2015, male age-standardized (world population) death rates per 100,000 were 5.03 in the European Union (EU), 8.33 in the Russian Federation, 2.53 in the United States (USA), and 3.04 in Japan; corresponding rates in women were 1.23, 1.23, 0.82, and 0.76. Male mortality decreased over the last decades in several European countries, with earlier and sharper declines in southern Europe; conversely, mortality was still increasing in a few eastern European countries and the United Kingdom. Mortality in men also decreased in Argentina, Australia, and Hong Kong, while it leveled off over more recent calendar years in Brazil, Japan, Mexico, the Republic of Korea, as well as in Australia and the USA. Female mortality slightly rose in various European countries. Overall incidence trends in the largest countries were broadly consistent with mortality ones, but oropharyngeal cancer incidence rose in many countries. Changes in tobacco and alcohol exposure in men over the last decades likely explain the favorable trends in oral and pharyngeal cancer mortality and incidence observed in selected countries worldwide, while increased human papillomavirus infection is likely responsible for the rise in oropharyngeal cancer incidence.     

Cancer mortality in Ireland, 1926-1995.

BACKGROUND: Investigation of long time series of cancer data can still be very useful in helping to identify Cancer Control priorities and achievements. Since the partition of Ireland into the independent Republic of Ireland and Northern Ireland, which remained part of the United Kingdom, cancer mortality data have been published in an essentially similar format in both countries. The information presented here will contribute to providing a basis for the collaborative Cancer Research programme initiated recently. PATIENTS AND METHODS: Cancer mortality data have been assembled and analysed separately for the Republic of Ireland and Northern Ireland: the data have then been combined to present mortality rates for the whole of Ireland, covering the period from 1926 to 1995. Several rubrics had to be aggregated to provide data continuously over the time span (e.g. colon and rectum and cervix and body of the uterus). When data were only available in 10-year classes of age, the EM algorithm was employed to obtain 5-year age-specific rates. All rates presented are age-standardised, employing the World Standard Population. RESULTS: In women, the death rate from all neoplasms combined increased very slightly from 117 per 100 000 in 1946-1950 to 120 per 100 000 in 1991-1995. In men, the death rate increased from 127 per 100 000 to 172 per 100 000 over the same time period. The overall cancer death rate in Ireland is currently similar to the European average in men, although in women it is among the top fifth of national cancer mortality rates in European countries. While cancer is a major cause of death in Ireland, there is no evidence of an evolving epidemic building up: the death rates from most forms of cancer are declining towards the end of the time period considered. CONCLUSIONS: As demonstrated by falling death rates from Hodgkin's disease and testicular cancer, major treatment advances appear to have been incorporated effectively into clinical practice in Ireland. Progress is apparent in tobacco control and further initiatives in this area must be undertaken since tobacco appears to be the only major new carcinogen introduced recently into the Irish environment during the period covered by this study. Effective population-based screening programmes for cervix and breast cancer and, more controversially, consideration of a National Prostate Cancer Screening programme, offer scope for further improvement in mortality. Examination of this long time series of mortality data from Ireland provides information about the evolving cancer pattern and provides the necessary background to evaluate the impact of the cross-border cancer research activities now being launched.     

Prostate cancer in Saskatchewan Canada, before and during the PSA era

Objectives: The purpose of this study was to describe changes in the incidence of prostate cancer and in survival of diagnosed cases, as well as prostate cancer-specific mortality, during a period spanning the introduction of prostate specific antigen (PSA) testing in Saskatchewan in 1990.Methods: All cases of neoplasms of the prostate (ICD-O = C61.9) diagnosed in Saskatchewan from 1970 to 1997 inclusive, were identified in the Saskatchewan Cancer Registry. A subgroup of adenocarcinomas was defined for further study. Age-adjusted and age-specific incidence rates, and actuarial and relative survival were calculated according to time period of diagnosis. Age-adjusted and age-specific mortality rates from prostate cancer were also calculated for each time period, using Vital Statistics data.Results: The age-adjusted incidence of prostate cancer was 60.5 per 10⁵ in 1970, rising gradually to 101.5 per 10⁵ in 1989. In 1990, incidence rose much more sharply, reaching a peak of 163.1 per 10⁵in 1993, after which it began to fall. This sharp increase coincided with the introduction and increasing use of the PSA test in the province. Relative survival of prostate cancer patients was stable from the late 1970s through the 1980s, then improved markedly in the 1990–94 period. After the introduction of the PSA test, the relative risk of death for prostate cancer patients was only about 60% of what it had been throughout the previous 15 years. Prostate cancer-specific death rates did not change from the early 1980s to the end of the study period.Conclusions: The above data are consistent with earlier diagnosis of prostate cancer due to PSA screening. Because mortality has not yet changed, it is premature to recommend widespread screening of asymptomatic men.