Impact of PSA testing and prostatic biopsy on cancer incidence and mortality: comparative study between the Republic of Ireland and Northern Ireland
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To investigate the impact of different PSA testing policies and health-care systems on prostate cancer incidence and mortality in two countries with similar populations, the Republic of Ireland (RoI) and Northern Ireland (NI).
Population-level data on PSA tests, prostate biopsies and prostate cancer cases 1993–2005 and prostate cancer deaths 1979–2006 were compiled. Annual percentage change (APC) was estimated by joinpoint regression.
Prostate cancer rates were similar in both areas in 1994 but increased rapidly in RoI compared to NI. The PSA testing rate increased sharply in RoI (APC = +23.3%), and to a lesser degree in NI (APC = +9.7%) to reach 412 and 177 tests per 1,000 men in 2004, respectively. Prostatic biopsy rates rose in both countries, but were twofold higher in RoI. Cancer incidence rates rose significantly, mirroring biopsy trends, in both countries reaching 440 per 100,000 men in RoI in 2004 compared to 294 in NI. Median age at diagnosis was lower in RoI (71 years) compared to NI (73 years) (p < 0.01) and decreased significantly over time in both countries. Mortality rates declined from 1995 in both countries (APC = −1.5% in RoI, −1.3% in NI) at a time when PSA testing was not widespread.
Prostatic biopsy rates, rather than PSA testing per se, were the main driver of prostate cancer incidence. Because mortality decreases started before screening became widespread in RoI, and mortality remained low in NI, PSA testing is unlikely to be the explanation for declining mortality.
KeywordsProstate cancer Trends PSA tests Incidence Mortality
Annual percentage change
National Cancer Registry Ireland
Northern Ireland Cancer Registry
Republic of Ireland
We are grateful to the staff of the Northern Ireland Cancer Registry and the National Cancer Registry Ireland who collected and processed the cancer registration data used in this paper. In particular, we thank Mr Colin Fox, Ms Wendy Hamill and Mr Richard Middleton for their help in providing the data from NI and Christine Buicke for reviewing death certificates in the RoI. We are also grateful to colleagues at HIPE, VHI Healthcare and BUPA for providing biopsy data, and staff in hospitals and laboratories for providing PSA data.
Competing interest statement
All authors declare that the answer to the questions on your competing interest form are all no and therefore have nothing to declare.
Details of contributors
AEC did the statistical analyses. FD collected and provided data on biopsies and PSA tests in the RoI. AB provided the data on PSA tests in NI. PL helped with prostate cancer grade and stage data collection in NI. DC provided the biopsy data in NI. FD, AB, LS, LM, PA, MB, HC and AG took part in the study design. AEC, FD, LS, PA, LE, HC, AG wrote and revised the article. All authors were involved in revisions and approved the final version. AEC is the guarantor for the study.
The Northern Ireland Cancer Registry is funded by the Public Health Agency Northern Ireland, and the National Cancer Registry of Ireland is funded by the Department of Health and Children (Republic of Ireland). Some aspects of the data collection for this study were funded by a grant from the Northern Ireland Research & Development Office and the Health Research Board (Dublin) [grant number NS/2004/20]. The study funders had no role in the study design, the collection, analysis and interpretation of the data. All authors were independent from the funding source.
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