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 keratinocyte cancers). In 2016, 19,305 prostate cancer cases were diagnosed in Australia.^[1] One in six Australian men are likely to be diagnosed with prostate cancer by the age of 85.^[1]

In 2018, prostate cancer was the cause of 3,264 deaths.^[1] It is the second most common cause of cancer death in Australian men after lung cancer.^[1] The ratio of prostate cancer mortality compared with incidence (deaths divided by new cases per year) is low compared with most other cancers.^[2] The number of new cases recorded in 2016 was six times the number of deaths.^[1]

Trends

Age-standardised incidence rates for prostate cancer have increased from 31.2 cases per 100,000 males in 1982 to 67.3 cases in 2016 (See Figure 1).^[1] Between 1982 and 2018, age-standardised mortality rates have reduced from 12.7 deaths per 100,000 males to 10.2 deaths (See Figure 1).^[1] 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.^[3]

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. ^[4] 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.^[5]

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^[4]. See Economic impact, below.

Figure 1. Trends of prostate cancer incidence and mortality in Australian men 1982-2020, rate per 100,000 men

Source: Australian Institute of Health and Welfare. Cancer data in Australia^[1]

Impact in relation to age

Prostate cancer mainly affects older men; it becomes more common as men age. More than 80% of men diagnosed with prostate cancer were aged over 60, and 60% of prostate cancer deaths occur in men over the age of 80.^[1]

Similarly, numbers of prostate cancer deaths increase significantly with age. Over 98% of men who died of prostate cancer in 2018 were aged over 60.^[1] Of the 68 deaths in Australian men under 60, four occurred in men under 50.^[1]

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^[6]. Therefore, 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.^[6]

Economic impact

On the most recent national data available, prostate cancer is the most expensive cancer in men in Australia, and the third most expensive overall.^[7] 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.^[7].

A state-based analysis by Access Economics estimated the total lifetime cost of prostate cancers diagnosed in New South Wales 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.^[8]