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Different spatial pattern of municipal prostate cancer mortality in younger men in Spain.

ABSTRACT: BACKGROUND:Prostate cancer (PC) primarily affects elderly men. However, the specific features of cases diagnosed at younger ages (<65 years) suggest that they may represent a different clinical subtype. Our aim was to assess this suggestion by contrasting the geographical PC mortality and hospital admissions patterns in Spain for all ages to those in younger men. METHODS:The Spanish National Institute of Statistics supplied data on PC mortality, hospital admission, and population data. We estimated the expected town-specific number of deaths and calculated the standardized mortality ratios. Spatial autoregressive models of Besag-York-Mollié provided smoother municipal estimators of PC mortality risk (all ages; <65 years). We computed the provincial age-standardized rate ratios of PC hospital admissions (all men; <60 years) using Spanish rates as the reference. RESULTS:A total of 29,566 PC deaths (6% among those <65 years) were registered between 2010-2014, with three high-mortality risk zones: Northwest Spain; Southwest Andalusia & Granada; and a broad band extending from the Pyrenees Mountains to the north of Valencia. In younger men, the spatial patterns shared the high risk of mortality in the Northwest but not the central band. The PC hospital discharge rates confirmed a North-South gradient but also low mortality/high admission rates in Madrid and Barcelona and the opposite in Southwest Andalusia. CONCLUSION:The consistent high PC mortality/morbidity risk in the Northwest of Spain indicates an area with a real excess of risk. The different spatial pattern in younger men suggests that some factors associated with geographical risk might have differential effects by age. Finally, the regional divergences in mortality and morbidity hint at clinical variability as a source of inequity within Spain.

SUBMITTER: Rodriguez-Sanchez L

PROVIDER: S-EPMC6347247 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Different spatial pattern of municipal prostate cancer mortality in younger men in Spain.

Rodriguez-Sanchez Lara L Fernández-Navarro Pablo P López-Abente Gonzalo G Nuñez Olivier O Fernández de Larrea-Baz Nerea N Jimenez-Moleón Jose Juan JJ Páez Borda Álvaro Á Pollán Marina M Perez-Gomez Beatriz B

PloS one 20190125 1

<h4>Background</h4>Prostate cancer (PC) primarily affects elderly men. However, the specific features of cases diagnosed at younger ages (<65 years) suggest that they may represent a different clinical subtype. Our aim was to assess this suggestion by contrasting the geographical PC mortality and hospital admissions patterns in Spain for all ages to those in younger men.<h4>Methods</h4>The Spanish National Institute of Statistics supplied data on PC mortality, hospital admission, and population ...[more]

PMID: 30682085

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Project description:BackgroundNew disease mapping techniques widely used in small-area studies enable disease distribution patterns to be identified and have become extremely popular in the field of public health. This paper reports on trends in the geographical mortality patterns of the most frequent cancers in Spain, over a period of 20 years.MethodsWe studied the municipal spatial pattern of stomach, colorectal, lung, breast, prostate and urinary bladder cancer mortality in Spain across four quinquennia, spanning the period 1989-2008. Case data were broken down by town (8073 municipalities), period and sex. Expected cases for each town were calculated using reference rates for each five-year period. For map plotting purposes, smoothed municipal relative risks were calculated using the conditional autoregressive model proposed by Besag, York and Mollié, with independent data for each quinquennium. We evaluated the presence of spatial patterns in maps on the basis of models, calculating the variance in relative risk corresponding to the structured spatial component and the unstructured component, as well as the proportion of variance explained by the structured spatial component.ResultsThe mortality patterns observed for stomach, colorectal and lung cancer were maintained over the 20 years covered by the study. Prostate cancer and the tumours studied in women showed no defined spatial pattern, with the single exception of stomach cancer. The trend in spatial fractional variance indicated the possibility of a change in the spatial pattern in breast, bladder and colorectal cancer in women during the last five-year period. The paper goes on to discuss ways in which spatio-temporal data are depicted in the case of cancer, and review the risk factors that may possibly influence the respective tumours' spatial patterns.ConclusionIn men, the marked geographical patterns of stomach, colorectal, lung and bladder cancer remained stable over time. Breast, colorectal and bladder cancer in women show signs of the possible appearance of a spatial pattern in Spain and should therefore be monitored.

Project description:BackgroundEarly detection and treatment of asymptomatic men with advanced and high-risk prostate cancer (PCa) may improve survival rates.ObjectiveTo determine outcomes for men diagnosed with advanced PCa following prostate-specific antigen (PSA) testing who were excluded from the ProtecT randomised trial.Design, setting, and participantsMortality was compared for 492 men followed up for a median of 7.4 yr to a contemporaneous cohort of men from the UK Anglia Cancer Network (ACN) and with a matched subset from the ACN.Outcome measurements and statistical analysisPCa-specific and all-cause mortality were compared using Kaplan-Meier analysis and Cox's proportional hazards regression.Results and limitationsOf the 492 men excluded from the ProtecT cohort, 37 (8%) had metastases (N1, M0=5, M1=32) and 305 had locally advanced disease (62%). The median PSA was 17μg/l. Treatments included radical prostatectomy (RP; n=54; 11%), radiotherapy (RT; n=245; 50%), androgen deprivation therapy (ADT; n=122; 25%), other treatments (n=11; 2%), and unknown (n=60; 12%). There were 49 PCa-specific deaths (10%), of whom 14 men had received radical treatment (5%); and 129 all-cause deaths (26%). In matched ProtecT and ACN cohorts, 37 (9%) and 64 (16%), respectively, died of PCa, while 89 (22%) and 103 (26%) died of all causes. ProtecT men had a 45% lower risk of death from PCa compared to matched cases (hazard ratio 0.55, 95% confidence interval 0.38-0.83; p=0.0037), but mortality was similar in those treated radically. The nonrandomised design is a limitation.ConclusionsMen with PSA-detected advanced PCa excluded from ProtecT and treated radically had low rates of PCa death at 7.4-yr follow-up. Among men who underwent nonradical treatment, the ProtecT group had a lower rate of PCa death. Early detection through PSA testing, leadtime bias, and group heterogeneity are possible factors in this finding.Patient summaryProstate cancer that has spread outside the prostate gland without causing symptoms can be detected via prostate-specific antigen testing and treated, leading to low rates of death from this disease.

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Different spatial pattern of municipal prostate cancer mortality in younger men in Spain.

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Different spatial pattern of municipal prostate cancer mortality in younger men in Spain.

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