Innos Kaire, Baburin Aleksei, Kotsar Andres, Eiche Ivar-Endrik, Lang Katrin
a Department of Epidemiology and Biostatistics , National Institute for Health Development , Tallinn , Estonia.
b Department of Urology and Kidney Transplantation , Clinic of Surgery, Tartu University Clinics , Tartu , Estonia.
Scand J Urol. 2017 Dec;51(6):442-449. doi: 10.1080/21681805.2017.1392600. Epub 2017 Nov 2.
The aim of this study was to analyze long-term trends in prostate cancer (PCa) incidence, mortality and survival in Estonia, with specific focus on age and stage.
Data on PCa incident cases and deaths in 1995-2014 were obtained from the Estonian Cancer Registry and the Causes of Death Registry, respectively. Joinpoint regression was used to estimate the annual percentage change for incidence and mortality trends. Relative survival ratios (RSRs) were calculated for four 5 year periods. Incidence and survival were analyzed by age and stage.
The average annual number of new PCa cases in Estonia increased more than three-fold from 1995-1999 to 2010-2014. The age-standardized overall incidence and the incidence of localized cancer increased steeply until 2011, then leveled off. The incidence of locally/regionally spread or distant PCa remained stable. A significant increase in PCa mortality was seen only in men aged 65 years and older. The overall 5 year RSR increased from 58% to 90% over the study period. Survival increased considerably for all stages.
The dramatic rise in the incidence of PCa in Estonia since the late 1990s was limited to localized cancers. This, together with rapid increases in survival, is probably due predominantly to extensive opportunistic prostate-specific antigen testing of middle-aged and elderly men. The ongoing increase in PCa mortality among older men warrants validation of causes of death to avoid possible overestimation. Evaluation of diagnostic and treatment strategies could identify possibilities for improving outcomes of non-localized PCa.
本研究旨在分析爱沙尼亚前列腺癌（PCa）的发病率、死亡率和生存率的长期趋势，特别关注年龄和分期。
分别从爱沙尼亚癌症登记处和死亡原因登记处获取1995 - 2014年PCa发病病例和死亡数据。采用Joinpoint回归估计发病率和死亡率趋势的年度百分比变化。计算四个5年期间的相对生存率（RSR）。按年龄和分期分析发病率和生存率。
从1995 - 1999年到2010 - 2014年，爱沙尼亚每年新确诊的PCa病例数增加了两倍多。年龄标准化的总体发病率和局限性癌症的发病率在2011年前急剧上升，然后趋于平稳。局部/区域扩散或远处PCa的发病率保持稳定。仅在65岁及以上男性中观察到PCa死亡率显著增加。在研究期间，总体5年RSR从58%增至90%。各分期的生存率均有显著提高。
自20世纪90年代末以来，爱沙尼亚PCa发病率的急剧上升仅限于局限性癌症。这与生存率的快速提高一起，可能主要归因于对中老年男性广泛开展的机会性前列腺特异性抗原检测。老年男性中PCa死亡率的持续上升需要对死亡原因进行核实，以避免可能的高估。对诊断和治疗策略的评估可以确定改善非局限性PCa治疗效果的可能性。
