Division of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
PLoS One. 2019 Feb 4;14(2):e0210434. doi: 10.1371/journal.pone.0210434. eCollection 2019.
Screening for prostate cancer is frequent in high-income countries, including Switzerland. Notably due to overdiagnosis and overtreatment, various organisations have recently recommended against routine screening, potentially having an impact on incidence, mortality, and surgery rates. Our aim was therefore to examine whether secular trends in the incidence and mortality of prostate cancer, and in prostatectomy rates, have recently changed in Switzerland.
We conducted a population-based trend study in Switzerland from 1998 to 2012. Cases of invasive prostate cancer, deaths from prostate cancer, and prostatectomies were analysed. We calculated changes in age-standardised prostate cancer incidence rates, stratified by tumor stage (early, advanced), prostate cancer-specific mortality, and prostatectomy rates.
The age-standardised incidence rate of prostate cancer increased greatly in men aged 50-69 years (absolute mean annual change +4.6/100,000, 95% CI: +2.9 to +6.2) between 1998 and 2002, and stabilised afterwards. In men aged ≥ 70 years, the incidence decreased slightly between 1998 and 2002, and more substantially since 2003. The incidence of early tumor stages increased between 1998 and 2002 only in men aged 50-69 years, and then stabilised, while the incidence of advanced stages remained stable across both age strata. The rate of prostatectomy increased markedly until 2002, more so in the 50 to 69 age range than among men aged ≥ 70 years; it leveled off after 2002 in both age strata. Trends in surgery were driven by radical prostatectomy. Since 1998, the annual age-standardised mortality rate of prostate cancer slightly declined in men aged 50-69 years (absolute mean annual change -0.1/100,000, 95% CI: -0.2 to -0.1) and ≥ 70 years (absolute mean annual change -0.5/100,000, 95% CI: -0.7 to -0.3).
The increases in the incidence of early stage prostate cancer and prostatectomy observed in Switzerland among men younger than 70 years have concomitantly leveled off around 2002/2003. Given the decreasing mortality, these trends may reflect recent changes in screening and clinical workup practices, with a possible attenuation of overdiagnosis and overtreatment.
在包括瑞士在内的高收入国家，前列腺癌的筛查十分常见。由于过度诊断和过度治疗，最近各种组织建议不再进行常规筛查，这可能会对发病率、死亡率和手术率产生影响。因此，我们旨在研究瑞士前列腺癌的发病率和死亡率以及前列腺切除术率是否最近出现了变化。
我们对瑞士 1998 年至 2012 年进行了一项基于人群的趋势研究。分析了侵袭性前列腺癌病例、前列腺癌死亡病例和前列腺切除术。我们按肿瘤分期（早期、晚期）分析了年龄标准化前列腺癌发病率的变化、前列腺癌特异性死亡率和前列腺切除术率。
1998 年至 2002 年期间，50-69 岁男性的年龄标准化前列腺癌发病率显著增加（绝对平均年变化率为+4.6/100,000，95%CI：+2.9 至+6.2），此后趋于稳定。70 岁以上男性的发病率在 1998 年至 2002 年期间略有下降，此后从 2003 年起大幅下降。早期肿瘤分期的发病率仅在 50-69 岁男性中在 1998 年至 2002 年期间有所增加，此后保持稳定，而晚期肿瘤分期的发病率在两个年龄组中均保持稳定。前列腺切除术的比例在 2002 年前显著增加，在 50 至 69 岁年龄组中比 70 岁以上年龄组更为明显；此后，两个年龄组的比例均趋于稳定。手术趋势主要由根治性前列腺切除术驱动。自 1998 年以来，50-69 岁男性的年龄标准化前列腺癌死亡率每年略有下降（绝对平均年变化率为-0.1/100,000，95%CI：-0.2 至-0.1）和 70 岁以上男性（绝对平均年变化率为-0.5/100,000，95%CI：-0.7 至-0.3）。
瑞士 70 岁以下男性的早期前列腺癌发病率和前列腺切除术的增加在 2002/2003 年左右同时趋于平稳。考虑到死亡率的下降，这些趋势可能反映了最近筛查和临床检查实践的变化，可能减轻了过度诊断和过度治疗的影响。
