Trends in prostate cancer epidemiology in the year 2000

In North America and Europe during the last 20 years prostate cancer incidence rates progressively increased, peaked in early 1990s and then declined. Newly diagnosed prostate cancers are being detected at an early stage in men presenting with no symptoms with abnormal prostate specific antigen (PSA) level. The proportion of patients treated by radical prostatectomy has increased and the proportion of those treated with hormonal therapy has decreased. The widespread of PSA testing seems to be the cause of the changes in the prostate cancer incidence rates and of the stage migration towards localized disease, but the effective benefit of prostate cancer screening in terms of reduction of cancer related mortality is still to be demonstrated. Definitive evidence on the effectiveness of prostate cancer screening with PSA should come from the results of large-scale screening trials that are still ongoing. In Italy the total number of newly diagnosed cases has been steadily increasing from the early 1980s to the mid 1990s both in Lombardia and Umbria regions. Survival rates dramatically improved from 37-48% to 74-76%, but no trendfor mortality was observed.