Stage-standardized and stage-specific survival among men with prostate cancer in the Nordic countries 2004-16: the NORDCAN survival studies.

Abstract

BACKGROUND Prostate cancer survival varies across Nordic countries, potentially reflecting variation in stage distribution at diagnosis. To highlight the variation in the diagnostic intensity of prostate cancer, we outlined the differences in stage distributions at diagnosis across these countries. Specifically, we evaluated whether the variation in cancer survival could be attributed to differences in stage at diagnosis. METHODS In this population-based cohort study, we identified 243 893 men diagnosed with prostate cancer from 2004 to 2016 in Denmark, Iceland, Norway, and Sweden. Country-specific stage distributions at diagnosis were obtained from individual cancer registry records provided by the NORDCAN collaboration. Relative survival and 95% confidence intervals (CIs) were estimated by using the Pohar Perme estimator. Stage-standardized relative survival was estimated by applying pre-weighting based on the stage distribution of the entire Nordic cohort. RESULTS The stage distribution of prostate cancer varied between the Nordic countries, with the highest proportion of early-stage (0-I) cases in Sweden and the highest proportion of advanced-stage (IV) cases in Denmark. When adjusting for differences in stage distribution (i.e. stage standardization), the 5-year relative survival improved in Denmark and Norway within the study period (2004-17), increasing from 83.9% (95% CI, 83.2-84.6) and 91.4% (95% CI, 90.8-92.0) to 87.3 (95% CI, 86.5-88.2) and 93.4% (95% CI, 92.8-94.1). Conversely, the 5-year relative survival declined in Sweden from 90.6% (95% CI, 90.3-91.0) to 88.5% (95% CI, 88.0-89.1). CONCLUSION The distinct differences in stage distributions between the Nordic countries substantially contributed to the variation in prostate cancer survival.