Prostate Cancer Incidence, Mortality, and Survival in Switzerland.

Importance: Prostate cancer (PCa) incidence and prognosis have changed substantially worldwide in recent decades, driven in part by early detection recommendations. Some countries such as the US have shown a rise in metastatic PCa incidence following recommendations against routine PCa screening around 2012. Objective: To evaluate trends in PCa incidence, mortality, and relative survival across age and prognostic groups and guide policy and practice in Switzerland. Design, Setting, and Participants: This cohort study included all registered cases of primary PCa based on data from the Swiss National Agency for Cancer Registration and the Swiss Federal Statistical Office from January 1, 1980, to December 31, 2021. Data were analyzed from January 8, 2024, until February 20, 2026. Exposure: Diagnosis of PCa. Main Outcomes and Measures: Age-standardized incidence and mortality rates and relative survival to 10 years after diagnosis were estimated. Subgroup analyses were conducted by age, Surveillance, Epidemiology, and End Results stage, Union for International Cancer Control stage, and Gleason score. Results: The study included 142 665 cases of primary PCa registered in Switzerland between 1980 and 2021, 100 102 (70.2%) of which were men aged 60 to 79 years. From 1980 to 2004, PCa incidence increased to 226.6 (95% CI, 218.8-234.7) per 100 000 men; it decreased markedly to 173.5 (95% CI, 168.9-178.2) per 100 000 men between 2011 and 2014, then increased again to 220.6 (95% CI, 216.0-225.3) per 100 000 men in 2021. These trends were primarily observed for localized, stage I to II PCa and PCa with a Gleason score of 7 or less in men aged 50 to 79 years. Incidence of distant and stage IV PCa increased after 2011, while incidence of PCa with a Gleason score of 8 to 10 remained relatively stable. PCa mortality declined continuously from the early 1990s to 34.8 (95% CI, 32.9-36.8) per 100 000 men in 2021, while 10-year relative survival increased from 46.2% (95% CI, 43.7%-48.8%) in 1982 to 1991 to 88.5% (95% CI, 86.6%-90.5%) in 2012 to 2021. The 10-year relative survival among men with localized PCa (99.2%; 95% CI, 96.0%-102.4%) was similar compared with men from the general population. Conclusions and Relevance: In this population-based cohort study, trends in PCa incidence in Switzerland suggest that overdiagnosis of lower-risk PCa increased and that there was a concurrent rise in cancers diagnosed in advanced stages alongside improvements in overall prognosis. These findings further suggest substantial potential for optimizing early detection of PCa.