Prostate cancer.

Trends in prostate cancer incidence and mortality are examined for men in England, Italy, Japan, Sweden and the USA. Incidence rose during the period 1968-1972 to 1983-1987 in all these populations. A substantial portion of this increase may be due to increased detection rates. However, mortality also has risen during this period in most of the populations. Although some of the increased mortality may be due to changes in death certification, the possibility of real increases in incidence of aggressive disease cannot be excluded. Large international and interethnic differences are evident for both incidence and mortality, in all time periods. Interpretation of the differences in incidence is complicated by international and interethnic differences in detection rates. The differences in mortality are unlikely to be due entirely to differences in death certification. The temporal rise in incidence demonstrated by all these populations suggests worldwide increases in health care costs for prostate cancer. Since a large part of the increased incidence seems to be due to increased detection rates of localized disease that would otherwise have remained asymptomatic, the increased costs may not be associated with concomitant reductions in morbidity and mortality.