Impact

From National Cancer Control Policy

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Impact

Prostate cancer in Australia

Incidence and mortality

Prostate cancer is the most common cancer diagnosed in men and the most common cancer diagnosed in Australia (apart from non-melanoma skin cancer). It is the second most common cause of cancer death in Australian men after lung cancer[1].

In 2014, 18,291 prostate cancer cases were diagnosed in Australia[2]. In 2015, prostate cancer was the cause of 3,195 deaths[2].

One in six Australian men are likely to be diagnosed with prostate cancer by the age of 85[2].

The ratio of prostate cancer incidence compared with mortality – i.e. the number of cases diagnosed each year compared with the number of deaths – is high compared with most other cancers. The number of new cases recorded in 2015 was six times the number of deaths[2].

Trends

Prostate cancer incidence rates increased by 88% between 1990 and 2010, while mortality rates fell by over 20% in the same period (See Figure 1)[3]. The increased incidence is thought to reflect an increase in detection of prostate cancer rather than a true increase in incidence, as the rise closely followed the increasing use of prostate-specific antigen (PSA) testing for the disease[4].

It is likely that PSA testing uncovered a large pool of undiagnosed, asymptomatic prostate cancer cases that may not otherwise have been diagnosed until symptoms developed, or may never have been diagnosed[5]. While the fall in prostate cancer mortality might indicate a beneficial effect of PSA testing, it is also likely to be attributable to improvements in treatment[6].

Increases in PSA testing and screening have been accompanied by an increase in hospital admissions and in prostatectomies and other treatments (e.g. radiotherapy) for prostate cancer[5]. See Economic impact, below.


Figure 1. Trends of prostate cancer incidence and mortality in Australian men 1982-2010, rate per 100,000 men

Prostate graph.PNG

Source: Australian Institute of Health and Welfare. Australian Cancer Incidence and Mortality Books[3]

Impact in relation to age

Prostate cancer mainly affects older men; it becomes more common as men age. Of the 19,233 Australian men diagnosed with prostate cancer in 2013, 15,389 (80% of cases) were aged over 60[2].

Numbers of prostate cancer deaths also increase significantly with age. Of the 3,102 Australian men who died of prostate cancer in 2014, 3,037 (98%) were aged over 60. Of the 64 deaths in Australian men under 60, two occurred in men under 50[2].

Many prostate cancers grow slowly, so men who are older than 75 years or who have less than 10 years’ life expectancy at diagnosis of prostate cancer are more likely to die of other causes than of the cancer[7]. Men diagnosed with prostate cancer at an earlier age (e.g. in their 50s) are more likely to die from prostate cancer than men who were older at diagnosis, because they are more likely to live long enough for their cancer to progress and threaten their life[7].


Quality of life issues

Irrespective of the risk it poses to life expectancy, a diagnosis of prostate cancer at any age can have a major impact on a man’s quality of life. Depression, anxiety, stress, fatigue, pain and psychosocial factors all affect the patient diagnosed with prostate cancer[8].

Side effects from prostate cancer treatment have also been shown to adversely affect the quality of life of prostate cancer survivors. Significant numbers of men treated for prostate cancer, and their partners, have reported reduced quality of life as a result of common side effects such sexual dysfunction and incontinence[9][10].

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Economic impact

Prostate cancer is the most expensive cancer in men in Australia, and the third most expensive overall[11]. In 2008-09, health system expenditure on prostate cancer was $347 million, accounting for almost 8% of all health system expenditure on cancer. Of this, $195 million was for hospital inpatient costs, $122 million for prescription pharmaceuticals and $30 million for out of hospital costs[11].

Prostate cancer health system expenditure in Australia has increased significantly, from $201 million in 2000-01[12] and $101 million in 1993-94[13].

A NSW assessment estimated the total lifetime cost of prostate cancers diagnosed in NSW in 2005 was approximately $2.2 billion. This amount included $297 million in health system and other financial costs (including lost productivity) and $1.9 billion in lost wellbeing and premature death[14].

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References

  1. Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer in Australia: an overview, 2012. Canberra: AIHW; 2012. Report No.: Cancer series no. 74. Cat. no. CAN 70.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Australian Institute of Health and Welfare. Australian Cancer Incidence and Mortality (ACIM) books. [homepage on the internet] Canberra: AIHW; 2017 Available from: http://www.aihw.gov.au/acim-books/.
  3. 3.0 3.1 Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) books. Canberra: AIHW; 2014 Available from: http://www.aihw.gov.au/acim-books/.
  4. Australian Institute of Health and Welfare. Key indicators of progress for chronic disease and associated determinants: data report. Canberra: AIHW; 2011 Jun. Report No.: Cat. no. PHE 142. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737419243&libID=10737419242.
  5. 5.0 5.1 Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer in Australia: an overview, 2006. Canberra: AIHW; 2007. Report No.: Cancer series no. 37. Cat. no. CAN 32. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442454559.
  6. Smith DP, Supramaniam R, Marshall VR, Armstrong BK. Prostate cancer and prostate-specific antigen testing in New South Wales. Med J Aust 2008 Sep 15;189(6):315-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18803534.
  7. 7.0 7.1 Baade PD, Steginga SK, Pinnock CB, Aitken JF. Communicating prostate cancer risk: what should we be telling our patients? Med J Aust 2005 May 2;182(9):472-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15865593.
  8. De Sousa A, Sonavane S, Mehta J. Psychological aspects of prostate cancer: a clinical review. Prostate Cancer Prostatic Dis 2012 Jun;15(2):120-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22212706.
  9. Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 2008 Mar 20;358(12):1250-61 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18354103.
  10. Clark JA, Inui TS, Silliman RA, Bokhour BG, Krasnow SH, Robinson RA, et al. Patients' perceptions of quality of life after treatment for early prostate cancer. J Clin Oncol 2003 Oct 15;21(20):3777-84 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/14551296.
  11. 11.0 11.1 Australian Institute of Health and Welfare. Health system expenditure on cancer and other neoplasms in Australia 2008-09. Canberra: AIHW; 2013 Dec 16. Report No.: Cancer series 81. Cat. no. CAN 78. Available from: http://aihw.gov.au/publication-detail/?id=60129545611.
  12. Australian Institute of Health and Welfare. Health system expenditures on cancer and other neoplasms in Australia, 2000-01. Canberra: AIHW; 2005 May. Report No.: HWE 29 no. 22. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442457403.
  13. Mathers C, Penm R, Sanson-Fisher R, Carter R, Campbell E. Health system costs of cancer in Australia 1993-1994. Canberra: Australian Institute of Health and Welfare, National Cancer Control Initiative; 1998. Report No.: Cat. No. HWE 8. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442457224.
  14. Access Economics Pty Ltd. Cost of cancer in NSW. Sydney: Access Economics; 2007 Apr. Sponsored by Cancer Council NSW. Available from: http://www.cancercouncil.com.au/wp-content/uploads/2010/11/costofcancer_summary.pdf.

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