Decrease in prostate cancer incidence and mortality in Germany - effects of opportunistic PSA screening or more?

Background: An increasing incidence and controversial interpretations about the valuation of improved survival rates are the main subjects of the discussion dealing with the epidemiology of the prostate carcinoma. In this study the most recent data of the Cancer Registry Schleswig-Holstein (the northernmost state of Germany) are introduced. Materials and Methods: Data from the population-based cancer registry covering a population of 2.8 million inhabitants were evaluated descriptively for the years 1999–2005. Results: The frequency of more prognostic favourable diagnosis rose in the analyzed period. In 2000–2001, 62.9% of the patients were diagnosed with stage I/II and in 2004–2005 the percentage rose to 67.9%. From 1999 to 2003 the age-adjusted incidence increased by 30% and declined to the level of 1999 within 2 years. Mortality decreased continuously and from 1999 to 2005 it dropped by 20%. Conclusion: We assume that a selected group of men in Schleswig-Holstein has been screened regularly by PSA testing. The rise of incidence could be interpreted as a typical effect of a screening prevalence round. Thereafter the incidence declined because of the initial screening effect. However, it is not yet evident whether the PSA tests will have further effects on mortality rates.