world cancer report - iarc

CANCERS OF THE MALE REPRODUCTIVE TRACT
SUMMARY
> Prostate cancer accounts for about
200,000 deaths annually worldwide,
predominantly afflicting older men in
developed countries.
> Risk factors include high caloric intake
and low physical activity. Black men
have the highest, white men an intermediate,
and Asian men a lower risk.
Recorded incidence is increasing in
many countries, partly as a result of
screening for elevated serum levels of
prostate-specific antigen.
> Testicular cancer mainly affects young
men, with close to 50,000 new cases
each year worldwide. Incidence is
increasing in many developed countries;
its etiology is largely unknown.
> The mean five-year survival rate is higher
than 95% mainly due to the efficacy of
chemotherapy using cisplatin; long-term
disease-free survival can even be
achieved in cases of metastatic testicular
cancer.
PROSTATE CANCER
Definition
The majority of prostate cancers are adenocarcinomas
of a heterogeneous nature,
which develop primarily in the peripheral
zone of the prostate gland.
Epidemiology
Prostate cancer is the third most common
cancer in men in the world, with 543,000
new cases each year. In the majority of
more developed and developing countries,
prostate cancer is the most commonly diagnosed
neoplasm affecting men beyond middle
age.
In recent times, incidence rates (Fig. 5.45)
of prostate cancer have been influenced by
the diagnosis of latent cancers (whose pres-
208 Human cancers by organ site
< 7.6
< 14.5
Fig. 5.45 The global incidence of prostate cancer. Rates are highest in developed countries and in some
parts of Africa.
ence has been suggested by screening of
asymptomatic individuals) and also by
detection of latent cancer in tissue removed
during prostatectomy operations, or at
autopsy. Thus, especially where screening
examinations are prevalent, recorded incidence
may be very high by comparison with
earlier levels. In the USA, for example, the
introduction of screening using prostatespecific
antigen (PSA) testing has led to an
enormous increase in the diagnosis of
prostate cancer, recorded incidence now
reaching 104 cases per 100,000 population,
making it by far the most commonly
diagnosed cancer in men (Screening for
prostate cancer, p160). Similar changes
have been observed in Australia, Finland
and Sweden. However, incidence rates and,
to a lesser extent, mortality rates are rising
in many other countries where a possible
impact of screening may be excluded. There
is even a recognized increase in those Asian
countries where risk is low, e.g. in Japan and
China, as well as in Africa. Such changes
suggest the influence of lifestyle or environmental
factors in etiology.
< 23.7
< 34.7
Age-standardized incidence/100,000 population
< 104.3
The prevalence of latent prostate cancer
shows much less geographic and ethnographic
variation than clinical prostate
cancer, where the ethnicity-specific rankings
are much the same as for incidence
[1]. The lifetime risk for microfocal cancer
is estimated to be at least 30% of the
male population, with progression to clinical
cancer occurring in about 10%, while
the lifetime risk of dying from prostate
cancer is approximately 3%.
Incidence and mortality increase with
ageing, with peaks somewhere within the
seventh decade, depending on the
degree of awareness and the establishment
of population screening programmes
in different populations. The
low fatality rate means that many men
are alive following a diagnosis of prostate
cancer – an estimated 1.37 million at five
years in 2000 - making this the most
prevalent form of cancer in men. More
than any other, this is a cancer of the
elderly. Thus, about three-quarters of
cases worldwide occur in men aged 65 or
above.