ArticleThe Lancet. Oncology2008
Prostate-cancer mortality in the USA and UK in 1975-2004: an ecological study.
Article in The Lancet. Oncology, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 79 papers, 3 of them syntheses that pooled it.
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Who cites it
79 citing papers in PubMed, 3 syntheses or guidelines pooled it, 270 citations in OpenAlex.
- Neutrophil-to-Lymphocyte Ratio Predicts PSA Response and Prognosis in Prostate Cancer: A Systematic Review and Meta-Analysis.PloS one · 2016Pooled it
- Screening for prostate cancer.The Cochrane database of systematic reviews · 2013Pooled it
- Pooled it
- Presenting treatment options to men with clinically localized prostate cancer: the acceptability of active surveillance/monitoring.Journal of the National Cancer Institute. Monographs · 2012Trial
- Global trends in testicular and prostate cancer among adolescents and young adult males aged 15-49 years, 1990-2021: insights from the GBD study.Scientific reports · 2025Article
- Immunologic Assessment of Tumors from a Race-matched Military Cohort Identifies Mast Cell Depletion as a Marker of Prostate Cancer Progression.Cancer research communications · 2023Article
- Epidemiology of Urological Cancers in Brazil: Trends in Mortality Rates Over More Than Two Decades.Journal of epidemiology and global health · 2022Article
- Review
- UPDATE - 2022 Canadian Urological Association recommendations on prostate cancer screening and early diagnosis Endorsement of the 2021 Cancer Care Ontario guidelines on prostate multiparametric magnetic resonance imaging.Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2022Article
- Prostate Cancer Incidence and Mortality: Global Status and Temporal Trends in 89 Countries From 2000 to 2019.Frontiers in public health · 2022Article
- Article
- Socioeconomic disparities in cancer incidence and mortality in England and the impact of age-at-diagnosis on cancer mortality.PloS one · 2021Article
- Differences in Prostate Cancer Incidence and Mortality in Lower Saxony (Germany) and Groningen Province (Netherlands): Potential Impact of Prostate-Specific Antigen Testing.Frontiers in oncology · 2021Article
- Personalized strategies in population screening for prostate cancer.International journal of cancer · 2020Review
- Estimates of over-time trends in incidence and mortality of prostate cancer from 1990 to 2030.Translational andrology and urology · 2020Article
- Trends in prostate cancer mortality in the state of São Paulo, 2000 to 2015.Revista de saude publica · 2020Article
- Superior survival benefits of Radical Prostatectomy than External Beam Radiotherapy in aging 75 and older men with high-risk or very high-risk Prostate Cancer: a population-matched study.Journal of Cancer · 2020Article
- Article
- Avoidable flaws in observational analyses: an application to statins and cancer.Nature medicine · 2019Article
- Epidemiology of Prostate Cancer.World journal of oncology · 2019Review
19 more citing papers are in PubMed but not listed here.
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Authors and funding
11 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundThere is no conclusive evidence that screening based on serum prostate-specific antigen (PSA) tests decreases prostate-cancer mortality. Since its introduction in the USA around 1990, uptake of PSA testing has been rapid in the USA, but much less common in the UK. Our aim was to study trends over time in prostate-cancer mortality and incidence in the USA and UK in 1975-2004, and compare these patterns with trends in screening and treatment.
methodsJoinpoint regression analysis of cancer-mortality statistics from Cancer Research UK (London, UK) and from the US National Cancer Institute Surveillance, Epidemiology and End Results (SEER) programme from 1975 to 2004 was used to estimate the annual percentage change in prostate-cancer mortality in both countries and the points in time when trends changed. The ratio of USA to UK age-adjusted prostate-cancer incidence was also assessed.
findingsAge-specific and age-adjusted prostate-cancer mortality peaked in the early 1990s at almost identical rates in both countries, but age-adjusted mortality in the USA subsequently declined after 1994 by -4.17% (95% CI -4.34 to -3.99) each year, four-times the rate of decline in the UK after 1992 (-1.14% [-1.44 to -0.84]). The mortality decline in the USA was greatest and most sustained in patients aged 75 years or older (-5.32% [-8.23 to -2.32]), whereas death rates had plateaued in this age group in the UK by 2000. The mean ratio of USA to UK age-adjusted prostate-cancer incidence rates in 1975-2003 was 2.5, with a pronounced peak around the time that PSA testing was introduced in the USA. Numbers needed to treat to prevent one death from prostate cancer were 33 000 in the 55-64-year age group.
interpretationThe striking decline in prostate-cancer mortality in the USA compared with the UK in 1994-2004 coincided with much higher uptake of PSA screening in the USA. Explanations for the different trends in mortality include the possibility of an early effect of initial screening rounds on men with more aggressive asymptomatic disease in the USA, different approaches to treatment in the two countries, and bias related to the misattribution of cause of death. Speculation over the role of screening will continue until evidence from randomised controlled trials is published.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.