Decline in prostate cancer mortality from 1980 to 1997, and an update on incidence trends in Olmsted County, Minnesota

Purpose: We describe trends in prostate cancer mortality from 1980 to 1997, before and after the introduction of serum prostate specific antigen (PSA) testing to the community medical practice, and provide an update on trends in incidence since 1992. Materials and Methods: All men with a diagnosis of prostate cancer who died between 1980 and 1997 were identified and parts 1 and 2 of the death certificates were reviewed for a diagnosis of prostate cancer. In addition, all men with biopsy proved prostate cancer diagnosed between 1983 and 1995 were identified. The complete medical records of incident cases of prostate cancer were reviewed for signs and symptoms at diagnosis and for the first treatment received. Results: Age adjusted, community mortality rates from prostate cancer increased from 25.8/ 100,000 men in 1980 to 1984 to a peak of 34/100,000 in 1989 to 1992, and have since declined to 19.4/100,000 in 1993 to 1997 (22% decline in mortality, 95% confidence interval 49% decline to 17% increase). The overall age adjusted incidence rates which peaked at 209/100,000 person-years in 1992 as previously reported declined to 108/100,000 in 1993 and 132/100,000 in 1995. A similar pattern was observed for organ confined cancers. However, incidence rates for regional or distant disease were suggestive of a continuing downward trend from 1989 to 1992 compared to 1993 to 1995 (12% decline per year, p = 0.07). Conclusions: These data demonstrate that despite the increase in prostate cancer mortality rates in the mid to late 1980s, mortality rates in 1993 to 1997 are lower than in the years before serum PSA testing. While chance cannot be ruled out, the data suggest that increased screening for prostate cancer, particularly through PSA testing, may have led to declines in mortality from prostate cancer.