title: Comparison of prostate cancer survival in Germany and the USA: can differences be attributed to differences in stage distributions?
abstract: To better understand the influence of prostate-specific antigen (PSA) screening and other health system determinants on prognosis of prostate cancer, up-to-date relative survival (RS), stage distributions, and trends in survival and incidence in Germany were evaluated and compared with the United States of America (USA).
  
  
  
  Incidence and mortality rates for Germany and the USA for the period 1999-2010 were obtained from the Centre for Cancer Registry Data at the Robert Koch Institute and the USA Surveillance Epidemiology and End Results (SEER) database. For analyses on stage and survival, data from 12 population-based cancer registries in Germany and from the SEER-13 database were analysed. Patients (aged ≥ 15 years) diagnosed with prostate cancer (1997-2010) and mortality follow-up to December 2010 were included. The 5- and 10-year RS and survival trends (2002-2010) were calculated using standard and model-based period analysis.
  
  
  
  Between 1999 and 2010, prostate cancer incidence decreased in the USA but increased in Germany. Nevertheless, incidence remained higher in the USA throughout the study period (99.8 vs 76.0 per 100,000 in 2010). The proportion of localised disease significantly increased from 51.9% (1998-2000) to 69.6% (2007-2010) in Germany and from 80.5% (1998-2000) to 82.6% (2007-2010) in the USA. Mortality slightly decreased in both countries (1999-2010). Overall, 5- and 10-year RS was lower in Germany (93.3%; 90.7%) than in the USA (99.4%; 99.6%) but comparable after adjustment for stage. The same patterns were seen in age-specific analyses. Improvements seen in prostate cancer survival between 2002-2004 and 2008-2010 (5-year RS: 87.4% and 91.2%; +3.8% units) in Germany disappeared after adjustment for stage (P = 0.8).
  
  
  
  The survival increase in Germany and the survival advantage in the USA might be explained by differences in incidence and stage distributions over time and across countries. Effects of early detection or a lead-time bias due to the more widespread utilisation and earlier introduction of PSA testing in the USA are likely to explain the observed patterns.
authors.affiliation: University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Winter
authors.affiliation: Cancer Registry of Lower Saxony, Oldenburg, Germany.
authors.forename: Eunice
authors.initials: E
authors.lastname: Sirri
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany.
authors.forename: Lina
authors.initials: L
authors.lastname: Jansen
authors.affiliation: University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Wawroschek
authors.affiliation: Cancer Registry of Lower Saxony, Oldenburg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Kieschke
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Castro
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany.
authors.forename: Agne
authors.initials: A
authors.lastname: Krilaviciute
authors.affiliation: Saarland Cancer Registry, Saarbrücken, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Holleczek
authors.affiliation: Cancer Registry of Rhineland-Palatinate, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Emrich
authors.affiliation: Cancer Registry of Schleswig-Holstein, Institute of Cancer Epidemiology, University of Lübeck, Lübeck, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Waldmann
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany.|Division of Preventive Oncology, German Cancer Research Centre (DKFZ) and National Centre for Tumor Diseases (NCT), Heidelberg, Germany.|German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*; D015203:Reproducibility of Results; D012111:Residence Characteristics; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D017430:Prostate-Specific Antigen
keywords: incidence; mortality; period analysis; prostate cancer; survival trends