Epidemiology

The epidemiological features of prostatic carcinoma are:

• incidence of prostate cancer varies widely among populations worldwide
  • a low incidence is usually seen in Asian men while a higher incidence is observed in northern European countries
  • however the highest incidence is reported from African American men (1)
    
    
• in Europe the incidence rate is 214 cases per 1000 men (2)
  
  
• in the UK, it is the most common cancer and the second most common cause of death from cancer in adult males (2)
  • it is responsible for around 25% of the new diagnoses of malignant cancer in men in England and Wales
  • prostate cancer is the most common cancer in men, and the second most common cancer in the UK
    • in 2014, there were over 46,000 new diagnoses of prostate cancer, which accounts for 13% of all new cancers diagnosed. About 1 in 8 men will get prostate cancer at some point in their life
    • prostate cancer can also affect transgender women, as the prostate is usually conserved after gender-confirming surgery, but it is not clear how common it is in this population
    • more than 50% of prostate cancer diagnoses in the UK each year are in men aged 70 years and over (2012), and the incidence rate is highest in men aged 90 years and over (2012 to 2014)
    • out of every 10 prostate cancer cases, 4 are only diagnosed at a late stage in England (2014) and Northern Ireland (2010 to 2014)
    • total of 84% of men aged 60 to 69 years at diagnosis in 2010/2011 are predicted to survive for 10 or more years after diagnosis. When diagnosed at the earliest stage, virtually all people with prostate cancer survive 5 years or more: this is compared with less than a third of people surviving 5 years or more when diagnosed at the latest stage.

Prostate cancer is mainly a disease of older men:

• average age at diagnosis is 70 -74 years and the average age at mortality is 80-84 years
• rare before 50 years but after that the incidence increases steeply with age e.g.- age 55-59 the incidence rate is 155 per 100,000 men, in 65-69 it is 510 per 100,000, and by 75-79 the rate is 751 per 100,000.
• is the most common malignant condition in men over 65 years

50-60% of cases present with metastatic disease:

• vast majority are well differentiated adenocarcinomas (4)
• early, potentially curable, prostate cancers are either impalpable or have only a small nodule and a PSA that is usually less than 15 ng/ml (1)

Patients at higher risk of developing prostate cancer include:

• patients with a first degree relative with prostate or breast cancer
• there is probably also an increased risk of prostate cancer in Afro-Carribeans - there is a 3 fold increase in the incidence of the disease in black men compared to white men (regardless of the country of origin of the black man) (3)
• in the UK, a man's lifetime risk of being diagnosed with prostate cancer is 1 in 8 (6)
  • study evidence revealed that:
    • lifetime risk of being diagnosed with prostate cancer is approximately 1 in 8 for White men, 1 in 4 for Black men, and 1 in 13 for Asian men, whereas that of dying from prostate cancer is approximately 1 in 24 for White men, 1 in 12 for Black men, and 1 in 44 for Asian men

Reference:

• (1) National Cancer Institute 2011. Genetics of Prostate Cancer. Introduction
• (2) Heidenreich A et al. EAU Guidelines on Prostate Cancer. Part I: Screening, Diagnosis, and Treatment of Clinically Localised Disease. Eur Urol. 2011;59(1):61-71.
• (3) National Institute for Health and Clinical Excellence (NICE) 2019. Prostate cancer: diagnosis and treatment
• (4) Cancer Research UK 2011. Prostate Cancer - UK incidence statistics
• (5) Prostate Cancer Risk Management Programme Information for primary care; PSA testing in asymptomatic men. Evidence document. NHS Cancer Screening Programmes, 2010
• (6) Lloyd, T., Hounsome, L., Mehay, A. et al. Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008-2010. BMC Med 13, 171 (2015). https://doi.org/10.1186/s12916-015-0405-5