Open Access

Radical prostatectomies in Austria, 1997–2004

  • Gerald Haidinger1Email author,
  • Stephan Madersbacher2,
  • Georg Schatzl3 and
  • Christian Vutuc1
BMC Research Notes20081:48

DOI: 10.1186/1756-0500-1-48

Received: 12 February 2008

Accepted: 21 July 2008

Published: 21 July 2008

Abstract

Background

The introduction of PSA testing in Austria led to a steep increase of the incidence of prostate cancer. We want to present the course of the number of newly diagnosed cases of prostate cancer in Austria since 1997, and set these numbers in relation to the total of radical prostatectomies (with resection of lymph nodes) in the same time period. All numbers were retrieved from health statistics of Statistics Austria. The report period of cancer cases and of RPE comprises the years 1997–2004. All calculations were performed for totals as well as for 5-year age groups (40–89 years of age).

Findings

The number of prostate cancer cases rose from 1997 to 2004 by 35%, while the number of RPE rose by 94% in the same time period. The proportion of RPE in relation to new cases rose from 41% in 1997 to 59% in 2004.

Conclusion

A slight decrease of prostate cancer mortality can already be observed in Austria, but the question of over-treatment still awaits analysis.

Findings

Opportunistic Prostate-Specific-Antigen testing (PSA) of healthy men started at the beginning of the 1990s and led to a steep increase of prostate cancer incidence [13]. In Austria data on surgical treatment of prostate cancer are available since 1997. The purpose of this paper is to present the correlation between the number of newly detected cases and the number of radical prostatectomies with resection of lymph nodes (RPE) by 5 year age group.

Data on the number of newly detected cases and number of prostatectomies where obtained from Statistics Austria. The data on radical prostatectomies by age group are available since 1997 only. The data set covers the age group 40 to 89 years comprising a population of 1.738,655 men in the year 2000. Since cases are anonymized it is indeterminable whether newly detected cases are operated in the year of diagnosis or in the following year, if ever.

Cases treated by perineal cryosurgery were excluded, due to the small total number (0 to 2 cases per year).

The number of newly detected cases and of RPE (1997 through 2004) as well as the calculated percentage per year by 5 year age group are given in table 1. The absolute number of prostate cancer cases rose from 3999 in 1997 to 5416 in 2004 (+35.4%, all age groups). The absolute number of RPE rose from 1648 in 1997 to 3200 in 2004 (+94.2%, all age groups). The percentage of RPE in relation to the number of newly detected cases rises from 41% in 1997 to 59% in 2004 (all age groups). The increase of this percentage is observed in all age groups younger than 70 years but not in older age groups, the linear trend over time is significant for all age groups and for totals, except for age group 40–44 years.
Table 1

Number of newly detected cases of prostate cancer in Austria, and number of radical prostatectomies 1997–2004, as well as proportion of RPE/incidence, and P value for linear time trend, totals and 5-year age groups of men aged 40–89.

Age

1997

1998

1999

2000

2001

2002

2003

2004

 
 

Nndc

RPE

Nndc

RPE

Nndc

RPE

Nndc

RPE

Nndc

RPE

Nndc

RPE

Nndc

RPE

Nndc

RPE

 
 

n

n

%

n

n

%

n

n

%

n

n

%

n

n

%

n

n

%

n

n

%

n

n

%

P-value

40–44

3

4

>100

5

4

80

5

4

80

16

14

87

18

15

83

17

18

>100

22

17

77

25

25

100

0.338

45–49

26

21

81

40

37

92

44

35

80

74

71

96

85

81

95

95

87

92

125

123

98

109

118

>100

< 0.001

50–54

127

99

78

149

118

79

166

157

95

199

171

86

256

240

94

266

259

97

267

279

>100

254

258

>100

< 0.001

55–59

371

300

61

440

382

87

496

433

87

522

482

92

541

518

96

559

492

88

597

552

92

585

612

>100

< 0.001

60–64

490

369

75

528

359

68

589

454

77

784

688

88

907

798

88

995

884

89

1158

1067

92

1105

980

89

< 0.001

65–69

841

515

61

880

568

65

924

560

61

938

666

71

962

685

71

910

651

72

1065

842

79

1011

789

78

< 0.001

70–74

837

299

36

873

288

33

976

288

30

1042

355

34

1035

390

38

998

370

37

1074

500

47

1001

377

38

< 0.001

75–79

554

34

6

655

31

5

737

38

5

698

40

6

674

42

6

644

26

4

732

119

16

718

36

5

< 0.001

80–84

383

4

1

300

2

<1

316

0

0

333

1

<1

328

2

<1

339

0

0

403

38

9

367

2

<1

< 0.001

85–89

367

0

0

348

0

0

340

0

0

317

1

<1

322

1

<1

258

0

0

284

15

5

325

1

<1

< 0.001

Total

3999

1648

41

4218

1826

43

4593

1969

43

4923

2489

51

5128

2774

54

5081

2791

55

5727

3167

55

5416

3200

59

< 0.001

Nndc ... Number of newly detected cases.

RPE ... Radical Prostatectomy (with resection of lymph nodes).

P-value ... P value for linear time trend.

The increase of the incidence of prostate cancer is well documented for Austria [1, 2], however the absolute numbers are for the first time set in relation to the number of RPE nationwide. Within 8 years, the total number of RPE increased by 94.2%, thus nearly doubled, with the increase mainly occurring in the age group 55–69 years. Starting at age 70 years the percentage of RPE remains more or less stable on a substantially lower level.

The number of RPE we used in our calculations represents the official hospital discharge statistics of Austria comprising of the collected data of all hospitals (including private hospitals), but excludes a very small number of self-pay patients. Thus our results negligibly may underestimate the relation of RPE to the number of newly detected cases. A further limitation of our analyses is caused by legal constrains: due to data protection laws we are limited to the use of depersonalized data.

The increase of RPE in Austria can be explained by at least three factors: a) operation technique meliorated significantly, now is a standard procedure, perioperative mortality is low and the risk of postoperative morbidity such as incontinence and erectile dysfunction decreased in Austria [4, 5], consequently acceptance of RPE in patients increased. b) By the introduction of PSA testing the target group of prostate cancer screening shifted towards younger age groups, meaning that carcinoma more frequently is sought in younger men [3]. c) Because of the slow progression of most cases, RPE only makes sense when health status permits RPE and patients have a life expectancy of at least 10 years [6].

The high percentage of RPE in men younger than 70 years surely also is influenced by the fact that counselling (towards RPE or radiation therapy) in Austria is performed by urologists. In this context, it is worth mentioning, that the primary intention of this manuscript is to provide the data which can serve as a basis for a constructive discussion about counselling and the provision of the most adequate therapeutic regimes.

The reason for the more or less stable percentage in men aged 70 years or older may lie in the fact that therapy of prostate cancer in these patients more often relies on watchful waiting, active surveillance, external beam radiation, brachytherapy or hormonal treatment. Detailed data for these therapies are not available.

In conclusion, currently 59% of prostate cancer cases detected are treated by RPE, a percentage steadily rising from 1997 on. On one hand, the dramatic increase of RPE already leads to a slight reduction of prostate cancer mortality in Austria [3, 7], on the other hand the question of over-testing and over-treatment, and added morbidity remains unanswered and analyses are still pending for Austria.

Declarations

Authors’ Affiliations

(1)
Department of Epidemiology, Centre of Public Health, Medical University of Vienna
(2)
Department of Urology and Andrology and Ludwig Boltzmann Institute for Urological Oncology, Donauspital – SMZO
(3)
University Clinic for Urology, Medical University of Vienna

References

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Copyright

© Haidinger et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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