Prostate cancer incidence and mortality in the Baltic states, Belarus, the Russian Federation and Ukraine

BACKGROUND: Prostate cancer incidence varies internationally largely attributable to differences in prostate-specific antigen (PSA) use. The aim of this study was to provide the most recent detailed international epidemiological comparison of prostate cancer incidence and mortality in six north-eastern European countries (Belarus, Estonia, Latvia, Lithuania, the Russian Federation and Ukraine). METHODS: The number of incident prostate cancer cases was obtained from the countries national cancer registries. Prostate cancer mortality and corresponding population data were extracted from the WHO Mortality Database. Age-specific and age-standardised incidence and mortality rates were calculated (European Standard). The joinpoint regression model was used to provide an average annual percentage change and to detect points in time where significant changes in trends occurred. The observation period was between 13 (Ukraine) and 48 (Estonia) years regarding incidence and around 30 years regarding mortality. RESULTS: The comparison of prostate cancer incidence in six European countries showed almost sixfold differences in the age-adjusted rates in most recent years with highest incidence rates in Lithuania and Estonia. Through the observation period, overall a continuous rise was seen in incidence in all countries and a continuous rise in mortality, with a stabilisation in Estonia and a decrease in Lithuania in recent years. Data limitations included a descriptive design using ecological data. CONCLUSIONS: A widespread use of PSA testing seems to be responsible for the changes in the epidemiology of the disease in north-eastern European countries. Substantial variation in the incidence of prostate cancer in the Baltic states suggests the possibility that PSA performance and utilisation spread have had a major influence on observed incidence trends, with a lack of effect on prostate cancer mortality.