Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

contrast, mortality among migrants from
East Africa, of predominantly Asian
(Indian) ethnicity, are not high {966}.
Migrants from low-risk countries to areas
of higher risk show quite marked increases
in incidence (for example, Japanese
living in the United States). Some of this
change reflects an elimination of the
'diagnostic bias" influencing the international
incidence rates. Localized prostate
cancer forms a small proportion of cases
in Japan (24%) compared with 66-70% in
the U.S.A; incidence in Japan could be
3-4 times that actually recorded if, for
example, all transurethral prostatectomy
(TURP) sections were carefully examined
{2392}. However, rates in Japanese
migrants remain well below those in the
U.S. White populations, even in
Japanese born in the United States,
which suggests that genetic factors are
responsible for at least some of the differences
between ethnic groups.
Fig. 3.02 International trends in age-standardized mortality rates of prostate cancer (world standard).
Source: WHO/NCHS
Age distribution
The risk of prostate cancer rises very
steeply with age. Incidence of clinical
disease is low until after age 50, and then
increases at approximately the 9-10th
power of age, compared with the 5-6th
power for other epithelial cancers {488}.
Worldwide, about three-quarters of all
cases occur in men aged 65 or more.
Time trends
Time trends in prostate cancer incidence
and mortality have been greatly affected
by the advent of screening for raised levels
of serum Prostate-Specific Antigen
(PSA), allowing increasing detection of
preclinical (asymptomatic) disease
{2100}. In the USA, prostate cancer incidence
rates were increasing slowly up to
the 1980’s, probably due to a genuine
increase in risk, coupled with increasing
diagnosis of latent, asymptomatic cancers
in prostatectomy specimens, due to
the increasing use of TURP {2099}.
Fig. 3.03 Prostate cancer incidence: ASR (World) per 10 5 (1993-1997). 1 From D.M. Parkin et al. {2016}.
Beginning in 1986, and accelerating
after 1988, there was a rapid increase in
incidence. The recorded incidence of
prostate cancer doubled between 1984
and 1992, with the increase being mainly
in younger men (under 65) and confined
to localized and regional disease.
The incidence rates began to fall again in
1992 (1993 in Black males), probably
because most of the prevalent latent
cancers in the subset of the population
reached by screening had already been
detected {1467}. With the introduction of
PSA screening, there was also an
increase in the rate of increase in mortality,
but this was very much less marked
than the change in incidence. More
recently, (since 1992 in White men, 1994
in Black men), mortality rates have
decreased. The contribution that PSA
screening and/or improved treatment
has made to this decline has been the
subject of considerable debate {728,
763,1015}. The increased mortality was
probably partly due to mis-certification of
cause of death among the large number of
men who had been diagnosed with latent
prostate cancer in the late 80’s and early
90’s. The later decline may be partly due to
a reversal of this effect; it seems unlikely
that screening was entirely responsible.
International trends in mortality have
been reviewed by Oliver et al. {1956},
and in incidence and mortality by Hsing
et al. {1130}. The largest increases in
incidence, especially in younger men,
Acinar adenocarcinoma
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