Mortality trends for benign prostatic hyperplasia and prostate cancer in English populations 1979–2006

Study Type – Prevalence (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Benign prostatic hyperplasia is very common. It does not itself cause death, but its complications, and therapy, may. Prostatic cancer has recently overtaken lung cancer as the most commonly diagnosed cancer in men in England. Mortality rates for deaths attributed to benign prostatic hypertrophy have fallen dramatically over the past three decades. This is likely to be a consequence of improvements in quality of care of men with the condition. Over a similar period, mortality for prostate cancer initially increased, peaked in the 1990s, and since then has shown a decline. OBJECTIVE To determine mortality trends for benign prostatic hyperplasia (BPH) and prostate cancer in English populations, between1979 and 2006. SUBJECTS AND METHODS Analysis of datasets that include both the underlying cause and all other mentioned causes on death certificates (together, termed ‘mentions’): the Oxford Record Linkage Study, 1979–2006, and English national data, 1995–2006. RESULTS In the Oxford region, underlying‐cause mortality from BPH fell from 45 deaths per million in 1979 to 2.4 in 2006. For mentions, the respective rates were 93 and 7.1. In England, underlying‐cause mortality reduced from 9.2 deaths per million in 1995 to 4.5 deaths per million in 2006. For mentions, the rates were 20 and 9.9 deaths per million. When BPH was certified on death certificates, it was selected as the underlying cause of death on fewer than half. Underlying‐cause mortality for prostate cancer in Oxford increased from 213 deaths per million in 1979 to 335 by 1991, and thereafter declined to 253 deaths per million in 2006. Mentions‐mortality in Oxford followed a similar pattern. In later years, when there were comparable data for Oxford and England, the pattern of decline in England was similar to that in Oxford. Where mentioned, prostate cancer was coded as the underlying cause of death on three‐quarters of death certificates. CONCLUSIONS The fall in BPH mortality, evident in statistics on underlying cause, was confirmed by statistics on all certified causes of death. The fall is dramatic in scale, likely to be attributable to clinical care, and could be regarded as an indicator of improving standards of care. Mortality for prostate cancer increased, peaking in the 1990s, then decreased in recent years in rates as measured both by underlying cause and by mentions.