International trends in prostate-cancer mortality: the decrease is continuing and spreading P.D. Baade 1, *, M.D. Coory 2 & J.F. Aitken 1,3 1 Cancer Epidemiology Unit, Queensland Cancer Fund, Australia; 2 Health Information Centre, Queensland Health, Australia; 3 Associate Professor, School of Population Health, University of Queensland Received 14 August 2003; accepted in revised form 12 December 2003 Key words: mortality, prostate cancer, PSA, screening, trends. Abstract Objective: To measure recent changes in prostate-cancer mortality across 24 developed countries. Methods: Mortality data for men aged 50–79 years were obtained from the World Health Organisation mortality database and we assessed trends in age-standardised mortality rates using joinpoint regression models. Results: Significant reductions in prostate-cancer mortality were observed in United Kingdom, United States, Austria, Canada, Italy, France, Germany, Australia and Spain, and downward trends were also observable in the Netherlands, Ireland and Sweden. Conclusions: Mortality declines for prostate cancer are now evident in 12 out of the 24 developed countries considered in this analysis. Increases in PSA screening and better treatment of early-stage disease, possibly acting in combination, remain plausible hypotheses. Introduction Surveillance of mortality trends has a long and contin- uing tradition in health research and has generated many useful insights into the determinants of disease. For prostate cancer, Oliver and colleagues [1] reported a decrease in mortality during the 1990s for seven out of 24 industrialised countries. This was broadly consistent with a separate analysis that reported on decreases in USA, Canada, England, France and Austria [2]. Postu- lated reasons for these trends included decreases in the prevalence of risk factors leading to decreased incidence, changes to the way cause of death is assigned, better treatment, and increased prostate-specific antigen (PSA) screening [1]. Of these, the later attracted the most attention, but there were inconsistencies between the mortality trends and the uptake of PSA screening in some countries. For example, several experts have recently highlighted the lack of a mortality decline in Australia [1, 3], despite the high uptake of PSA testing in that country [4]. However, with additional years of data available, a reduction in mortality was recently reported for Aus- tralia [5]. This raises the possibility that other developed countries might have also experienced recent declines in prostate-cancer mortality. In this analysis we investigate whether mortality has decreased in any additional countries, and if the previously reported reductions in mortality have continued. Methods Mortality and population data were extracted from the World Health Organisation (WHO) mortality database (www.who.int/whosis/mort) for the period 1979–2001, extracting data for the 24 countries with sufficient quantity and quality of data to estimate trends. Addi- tional mortality data was obtained for Canada (1999 and 2000) from Canada Cancer Surveillance (http:// dsol-smed.hc-sc.gc.ca/dsol-smed/cancer/index_e.html) and for Australia from the Australian Bureau of Statistics (www.abs.gov.au). Population data for * Address correspondence to: Dr Peter Baade, Senior Research Fellow (Biostatistics), Cancer Epidemiology Unit, Queensland Cancer Fund, PO Box 201, Spring Hill QLD 4004, Australia. Ph.: +61-7- 3258-2309; Fax: +61-7-3258-2310; E-mail: peterb@qcfepi.org.au Cancer Causes and Control 15: 237–241, 2004. 237 Ó 2004 Kluwer Academic Publishers. Printed in the Netherlands.