Rafael Marcos Gragera
Epidemiologist at the Catalan Institute of Oncology and professor of medicine at the University of Girona
This is an ecologically designed study that analyzes prostate cancer incidence rates using consolidated data from population-based cancer registries published in the Cancer Incidence in Five Continents and mortality data provided by WHO. The approach of the study and the quality of the data used position it as a robust and well-supported analysis.
The study highlights a dramatic increase in prostate cancer cases in Europe since 1980, with variations between countries, mainly attributed to the widespread use of PSA testing. However, this increase in diagnoses has not been accompanied by a commensurate increase in mortality, suggesting that many of the cancers detected may be harmless and would not have impacted patients' lives had they not been diagnosed, indicating possible overdiagnosis. This overdiagnosis carries risks such as unnecessary treatments, impaired quality of life, and inefficient use of healthcare resources.
These findings are in line with recent studies in Spain that document an increase in the incidence of prostate cancer until 2003, followed by a decrease attributed to the reduction in opportunistic PSA determination. In addition, a progressive decrease in mortality and an increase in survival rates between 1994 and 2018 is observed.
This analysis is particularly relevant for the possible implementation of population-based prostate cancer screening programs. If their introduction is considered in the future, such programs should be carefully designed to minimize and monitor the adverse effects of overdiagnosis in the population.
The limitations of the study are those discussed by the authors and are inherent to ecologically designed studies.