Prostate cancer in Austria: impact of prostate-specific antigen test on incidence and mortality

The aim of the study was to assess the impact of prostate-specific antigen (PSA) testing on prostate cancer mortality in Austria. A join-point regression model and permutation tests were used to identify changes in the slope of age-specific trends respectively calculating the annual percentage change (APC). Age-adjusted incidence increased (P < 0.01) between 1983 and 1997 by 79% from 52.2 to 93.6 cases per 100 000 men/year. Incidence in localized/regional stage disease increased in all ages by 143% from 25.7 to 62.4 cases per 100 000 men/year. Incidence in distant disease decreased (P < 0.01) between 1983 and 1997 in all ages by 38% from 9.5 to 5.9 cases per 100 000 men/year. Incidence in unstaged disease increased (P < 0.01) between 1983 and 1997 in all ages by 300% from 4.5 to 18 cases per 100 000 men/year. Age-adjusted mortality increased (P < 0.05) by 13% from 26.8 in 1983 to 30.3 deaths per 100 000 men/year in 1999. No significant changes of trends in mortality rates were detected in the age groups 50-59 years. In the age group 70-79 years the trend changed (P < 0.05) direction in 1991 and in 1994; 1983 through 1991 APC = 3.52 (95% CI 1.37, 5.72), 1991 through 1994 APC = -10.27 (95% CI -26.20, 9.1) and 1994 through 1999 APC = -0.25 (95% CI -4.55, 4.24). PSA testing increased incidence but no impact on mortality in the target population can be observed so far.