title: Changes in mortality and incidence of prostate cancer by risk class in different periods in Italy: the possible effects of PSA spread.
abstract: OBJECTIVE
  In Italy, the spread of prostate-specific antigen (PSA) testing varies in different areas. A peak of incidence was reached in 2003-2004 in some areas, while in others the incidence is still increasing. Mortality has declined since 1999 in some areas, while it remains stable in others. We compared mortality and the risk of advanced cancer over 2 periods (1996-1998; 2005-2007) and by geographic area characterized by a different spread of PSA, to understand the possible impact of PSA on the epidemiology of prostate cancer.
  
  
  METHODS
  In 8 Italian Cancer Registries (CRs), 4,632 cases diagnosed over 2 periods, 1996-1998 and 2005-2007, were sampled to assess risk class. The CRs were classified into late and early phase of PSA testing depending on whether an incidence peak had been reached by 2008. Incidence by risk class was estimated based on overall incidence in each CR and on risk class distribution in the sample. We calculated standardized mortality (MRR) and risk class-specific incidence rate ratios (IRR) to compare the 2 periods.
  
  
  RESULTS
  Incidence increased from 1996-1998 to 2005-2007 (IRR 1.5; 95% CI 1.4, 1.6). High-risk and metastatic cancer incidence decreased only in late-phase areas (IRR 0.78; 95% CI 0.69, 0.88; and 0.40; 95% CI 0.30, 0.54, respectively), while in early-phase areas, incidence remained virtually stable (IRR 1.2; 95% CI 1.0, 1.4; and 0.77; 95% CI 0.59, 1.0, respectively). Mortality decreased only in late-phase areas (MRR 0.81; 95% CI 0.85, 0.97; vs 1.1; 95% CI 0.92, 1.2) in early-phase areas.
  
  
  CONCLUSIONS
  Mortality reduction and a decrease in high-risk and metastatic cases occurred simultaneously only in areas in late phase of PSA spread.
authors.affiliation: Interinstitutional Epidemiology Unit, AUSL Reggio Emilia, Reggio Emilia - Italy.|Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia - Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Vicentini
authors.affiliation: Interinstitutional Epidemiology Unit, AUSL Reggio Emilia, Reggio Emilia - Italy.|Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia - Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Sacchettini
authors.affiliation: Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Trama
authors.affiliation: Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Nicolai
authors.affiliation: Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
authors.forename: Gemma
authors.initials: G
authors.lastname: Gatta
authors.affiliation: Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan - Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Botta
authors.affiliation: Diagnostic Imaging and Radiotherapy, Università degli Studi di Milano, Milan - Italy.|Prostate Cancer Program and Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Valdagni
authors.affiliation: Interinstitutional Epidemiology Unit, AUSL Reggio Emilia, Reggio Emilia - Italy.|Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia - Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Giorgi Rossi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000097:blood / Q000401:mortality* / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen