Incidence and Survival of Patients With Prostate Cancer in North-Rhine Westphalia, Germany

Introduction: There is no organized prostate cancer screening in Germany. The aim of this study was to investigate the development of incidence and survival in patients with primary malignant tumors of the prostate in relation to changing recommendations of prostate-specific antigen (PSA) screening in guidelines.

Methods: Age-standardized incidence rates and 5-year relative survival (RS) (period approach) were calculated using data from the cancer registry North Rhine-Westphalia with the subset of the administrative district Münster respectively for the years 1992-2019. Analyses were stratified according to TNM classification.

Results: Until 2008 overall prostate cancer incidence increased, followed by a decrease up to 2017 and another increase thereafter. The same trend was observed in nonmetastatic but not in metastatic prostate cancer. Overall 5-year RS showed an increase of 10 percentage points up to period 2005-2009, followed by a constant RS. 5-year RS of patients with distant metastases remained constant from period 2000-2004 to 2015-2019, while 5-year RS with nonmetastatic prostate cancer and lymph node metastases increased slightly.

Discussion: Overall and nonmetastatic incidence rates reflect changes of recommendation in PSA screening guidelines from the United States. Accordingly, the increase in 5-year RS might be influenced by lead time bias. Incidence and survival of metastatic prostate cancer barely suggest any association with changing PSA screening recommendations.

Conclusion: Structured early detection of metastases with additionally applied diagnostic methods might improve 5-year RS rates of metastatic prostate cancer patients.