Prostate Cancer Mortality Trend in Montenegro 1990-2018
,
Abstract
Background: Prostate cancer is the fifth leading cause of cancer-related death among men worldwide, with an estimated 375,304 deaths in 2020 and a mortality rate of 7.7 deaths per 100,000. It stands as the leading cause of cancer mortality in 48 countries. We aimed to analyze the prostate cancer mortality trend in Montenegro for the period 1990-2018 using regression techniques.
Methods: The data concerning prostate cancer mortality in Montenegro from 1990 to 2018 was collected. Mortality rates were age-standardized to the World Standard Population for estimating both overall and gender-specific trends. The joinpoint, linear and Poason regression were applied for trend assessment.
Results: In Montenegro, during the period from 1990 to 2018, 1,184 individuals died from prostate cancer. The average annual number of deaths was 40.8, with an average age-standardized rate of 8.3. For the period 1990-2018, rates statistically significantly increased on average by 2.4% annually [AAPC (95%CI)=2.4% (1.4-3.4); P<0.001]. An increase in mortality rates was observed among individuals aged 65-74 by 1.1%, which was not statistically significant (P=0.452), and among those aged 75-84 by 2.7%, which was statistically significant [AAPC (95%CI)=2.7% (1.3-4.1); P<0.001]. Almost 50% of all deaths occurred in men aged 75-84, and nearly a third in the age group 65-74.
Conclusion: The rising trend in prostate cancer mortality indicates the need for more effective prevention, screening, early diagnosis, and treatment measures for prostate cancer in Montenegro with special focus on older men.
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2. Wang L, Lu B, He M, et al (2022). Prostate Cancer Incidence and Mortality: Global Status and Temporal Trends in 89 Coun-tries from 2000 to 2019. Front Public Health, 10: 811044.
3. Zhang W, Cao G, Wu F, et al (2023). Global Burden of Prostate Cancer and Associa-tion with Socioeconomic Status, 1990-2019: A Systematic Analysis from the Global Burden of Disease Study. J Epi-demiol Glob Health, 13 (3): 407-21.
4. Rawla P (2019). Epidemiology of Prostate Cancer. World J Oncol, 10 (2): 63-89.
5. Siegel RL, Miller KD, Fuchs HE, et al (2021). Cancer Statistics. CA Cancer J Clin, 71: 7-33.
6. Shahabi A, Corral R, Catsburg C, et al (2014). Tobacco smoking, polymor-phisms in carcinogen metabolism en-zymegenes, and risk of localized and advanced prostate cancer: results from the California Collaborative Prostate Cancer Study. Cancer Med, 3 (6): 1644-55.
7. Allott EH, Masko EM, Freedland SJ (2013). Obesity and prostate cancer: weighing the evidence. Eur Urol, 63 (5): 800–9.
8. Klein EA, Thompson IM Jr, Tangen CM, et al (2011). Vitamin E and the risk of pros-tate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JA-MA, 306: 1549–56.
9. Cai H, Xu Z, Xu T, et al (2015). Diabetes mellitus is associated with elevated risk of mortality amongst patients with pros-tate cancer: a metaanalysis of 11 cohort studies. Diabetes Metab Res Rev, 31 (4): 336–43.
10. Peisch SF, Van Blarigan EL, Chan JM, et al (2017). Prostate cancer progression and mortality: a review of diet and lifestyle factors. World J Urol, 35 (6): 867–74.
11. Culp MB, Soerjomataram I, Efstathiou JA, et al (2020). Recent global patterns in prostate cancer incidence and mortality rates. Eur Urol, 77 (1): 38–52.
12. Schröder FH, Hugosson J, Roobol MJ, et al (2014). Screening and prostate cancer mortality: results of the European Ran-domised Study of Screening for Prostate Cancer (ERSPC) at 13years of follow-up. Lancet, 384 (9959): 2027-35.
13. Leapman MS, Wang R, Park H, et al (2022). Changes in Prostate-Specific Antigen Testing Relative to the Revised US Pre-ventive Services Task Force Recom-mendation on Prostate Cancer Screen-ing. JAMA Oncol, 8 (1): 41-7.
14. Schroder FH, Roobol MJ (2012). Prostate cancer epidemic in sight? Eur Urol, 61 (6): 1093-5.
15. Wilt TJ, Brawer MK, Jones KM, et al (2012). Radical prostatectomy versus observa-tion for localized prostate cancer. N Engl J Med, 367 (3): 203-13.
16. Dickinson J, Shane A, Tonelli M, et al (2016). Trends in prostate cancer inci-dence and mortality in Canada during the era of prostate-specific antigen screening. CMAJ Open, 4 (1): E73-9.
17. Etzioni R, Tsodikov A, Mariotto A, et al (2008). Quantifying the role of PSA screening in the US prostate cancer mortality decline. Cancer Causes Control, 19 (2): 175–81.
18. Murray CJL, Aravkin AY, Zheng P, et al (2020). Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Glob-al Burden of Disease Study 2019. Lancet, 396 (10258): 1223-49.
19. Fitzmaurice C, Abate D, Abbasi N, et al (2019). Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and dis-ability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analy-sis for the Global Burden of Disease Study. JAMA Oncol, 5 (12): 1749-68.
20. Hugosson J, Roobol MJ, Månsson M, et al (2019). A 16-yr Follow-up of the Europe-an Randomized study of Screening for Prostate Cancer. Eur Urol, 76 (1): 43-51.
21. Ilic D, Djulbegovic M, Jung JH, et al (2018). Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ, 362: k3519.
22. Tikkinen KAO, Dahm P, Lytvyn L, et al (2018). Prostate cancer screening with prostate specific antigen (PSA) test: a clinical practice guideline. BMJ, 362: k3581.
23. Shoag JE, Nyame YA, Gulati R, et al (2020). Reconsidering the Tradeoffs of Prostate Cancer Screening. N Engl J Med, 382 (25): 2465–2468.
24. Van Poppel H, Hogenhout R, Albers P, et al (2021). Early detection of prostate can-cer in 2020 and beyond: facts and rec-ommendations for the European Union and the European Commission. Eur Urol, 79 (3): 327–329.
25. Van Poppel H, Roobol MJ, Chandran A (2023). Early Detection of Prostate Can-cer in the European Union: Combining Forces with PRAISE-U. Eur Urol, 84(6): 519-22
26. European Association of Urology. PRAISE-U: Personalised Risk Assessment in Screening Events-UroWeb. Available from: https://uroweb.org/praise-u
27. Kasivisvanathan V, Rannikko AS, Borghi M, et al (2018). PRECISION Study Group Collaborators. MRI-Targeted or Stand-ard Biopsy for Prostate Cancer Diagno-sis. N Engl J Med, 378(19): 1767-77.
28. Mottet N, van den Bergh RCN, Briers E,etal (2021). EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol, 79 (2): 243-62.
29. World Health Organization (2007). Interna-tional Statistical Classification of Dis-eases and Related Health Problems, 10th Revision.
30. Public Health Institute Podgorica (2010). Statistical Yearbook for 2009 on Popula-tion Health and Healthcare in Montene-gro. Podgorica. Printed version.
31. Institute of Public Health of Montenegro. Podaci o mortalitetu 2010-2019. Availa-ble from: https://www.ijzcg.me/me/izvjestaji/umrli-prema-uzroku-smrti-po-grupama-oboljenja-polu-i-starosti-u-crnoj-gori-2010-2019
32. World Health Organization (2001). Age standardization of rates: A new WHO standard. GPE Discussion Paper Series: No.31. https://cdn.who.int/media/docs/default-source/gho-documents/global-health-esti-ma-tes/gpe_discussion_paper_series_paper31_2001_age_standardization_rates.pdf
33. National Cancer Institute (2023). Joinpoint Regression Program, Version 5.0.2-May, 2023. Available from: https://surveillance.cancer.gov/joinpoint/
34. Kim HJ, Fay MP, Feuer EJ, et al (2000). Permutation tests for joinpoint regres-sion with applications to cancer rates. Stat Med, 19 (3): 335-51.
35. Reljić A, Čukelj P, Tomašković I, et al (2018). Epidemiology of Prostate Cancer in Croatia - Situation and Perspectives. Acta Clin Croat, 57(Suppl 1):27-34.
36. Šekerija M, Sekulić K (2016). Trends in prostate cancer incidence (1968-2013) and mortality (1960-2014) in Croatia: A joinpoint regression analysis. ENCR Scientific Meeting and General Assem-bly 2016.
37. Ilic M, Ilic I (2016). Prostate cancer mortali-ty in Serbia, 1991-2010: a joinpoint re-gression analysis. J Public Health (Oxf), 38 (2): e63-7.
38. Wang F, Wang C, Xia H, et al (2022). Bur-den of Prostate Cancer in China, 1990-2019: Findings from the 2019 Global Burden of Disease Study. Front Endocrinol (Lausanne), 13: 853623.
39. Spanjol J, Maricić A, Cicvarić T, et al (2007). Epidemiology of prostate cancer in the mediterranean population of Croatia--a thirty-three year retrospective study. Coll Antropol, 31(1) :235-9.
40. Catalona WJ (2018). Prostate Cancer Screening. Med Clin North Am,102(2): 199-214.
41. Martin RM, Donovan JL, Turner EL, et al (2018). Effect of a Low-Intensity PSA-Based Screening Intervention on Pros-tate Cancer Mortality: The CAP Ran-domized Clinical Trial. JAMA, 319(9): 883-95.
42. U.S. Preventive Services Task Force (2008). Screening for prostate cancer: U.S. Pre-ventive Services Task Force recommen-dation statement. Ann Intern Med, 149:185-91.
43. Moyer VA, U.S. Preventive Services Task Force (2012). Screening for prostate cancer: U.S Preventive Services Task Force recommendation statement. Ann Intern Med, 157 (2): 120–34.
44. Zargar H, van den Bergh R, Moon D, et al (2017). The impact of the United States Preventive Services Task Force (USPTSTF) recommendations against prostate-specific antigen (PSA) testing on PSA testing in Australia. BJU Int, 119 (1): 110–115.
45. de Carvalho TM, Heijnsdijk EAM, de Kon-ing HJ (2018). Comparative effectiveness of prostate cancer screening between the ages of 55 and 69 years followed by active surveillance. Cancer, 124 (3): 507-513.
46. Jemal A, Culp MB, Ma J, et al (2021). Pros-tate Cancer Incidence 5 Years after US Preventive Services Task Force Recom-mendations against Screening. J Natl Cancer Inst, 113 (1): 64–71.
47. Prostate Cancer Working Group of Geni-tourinary Cancer Committee in Chinese Anti-Cancer Association (2017). China consensus of prostate cancer screening. Zhonghua Wai Ke Za Zhi, 55(5):340-342.
48. Grossman DC, Curry SJ, Owens DK, et al (2018). Screening for Prostate Cancer: US Preventive Services Task Force Rec-ommendation Statement. JAMA, 319 (18): 1901– 13.
49. Callender T, Emberton M, Morris S, et al (2021). Benefit, Harm, and Cost-effectiveness Associated With Magnetic Resonance Imaging Before Biopsy in Age-based and Risk-stratified Screening for Prostate Cancer. JAMA Netw Open, 4 (3): e2037657.
50. Talala K, Walter S, Taari K, et al (2024). Screening history and risk of death from prostate cancer:a nested case-control study within the screening arm of the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC). Cancer Causes Control, 35(4):695-703.
51. Negoita S, Feuer EJ, Mariotto A, et al (2018). Annual Report to the Nation on the Status of Cancer, part II: Recent changes in prostate cancer trends and disease characteristics. Cancer, 124 (13): 2801–14.
52. Iser DA, Cobalchini GR, Oliveira MM, et al (2022). Prostate cancer mortality in Brazil 1990-2019: geographical distribu-tion and trends. Rev Soc Bras Med Trop, 55(suppl 1):e0277.
53. Silva GAE, Jardim BC, Ferreira V de M, et al (2020).Cancer mortality in the Capitals and in the interior of Brazil: a four-decade analysis. Rev Saude Publica, 54: 126.
54. Darcey E, Boyle T (2018). Tobacco smok-ing and survival after a prostate cancer diagnosis: A systematic review and meta-analysis. Cancer Treat Rev, 70: 30-40.
2. Wang L, Lu B, He M, et al (2022). Prostate Cancer Incidence and Mortality: Global Status and Temporal Trends in 89 Coun-tries from 2000 to 2019. Front Public Health, 10: 811044.
3. Zhang W, Cao G, Wu F, et al (2023). Global Burden of Prostate Cancer and Associa-tion with Socioeconomic Status, 1990-2019: A Systematic Analysis from the Global Burden of Disease Study. J Epi-demiol Glob Health, 13 (3): 407-21.
4. Rawla P (2019). Epidemiology of Prostate Cancer. World J Oncol, 10 (2): 63-89.
5. Siegel RL, Miller KD, Fuchs HE, et al (2021). Cancer Statistics. CA Cancer J Clin, 71: 7-33.
6. Shahabi A, Corral R, Catsburg C, et al (2014). Tobacco smoking, polymor-phisms in carcinogen metabolism en-zymegenes, and risk of localized and advanced prostate cancer: results from the California Collaborative Prostate Cancer Study. Cancer Med, 3 (6): 1644-55.
7. Allott EH, Masko EM, Freedland SJ (2013). Obesity and prostate cancer: weighing the evidence. Eur Urol, 63 (5): 800–9.
8. Klein EA, Thompson IM Jr, Tangen CM, et al (2011). Vitamin E and the risk of pros-tate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JA-MA, 306: 1549–56.
9. Cai H, Xu Z, Xu T, et al (2015). Diabetes mellitus is associated with elevated risk of mortality amongst patients with pros-tate cancer: a metaanalysis of 11 cohort studies. Diabetes Metab Res Rev, 31 (4): 336–43.
10. Peisch SF, Van Blarigan EL, Chan JM, et al (2017). Prostate cancer progression and mortality: a review of diet and lifestyle factors. World J Urol, 35 (6): 867–74.
11. Culp MB, Soerjomataram I, Efstathiou JA, et al (2020). Recent global patterns in prostate cancer incidence and mortality rates. Eur Urol, 77 (1): 38–52.
12. Schröder FH, Hugosson J, Roobol MJ, et al (2014). Screening and prostate cancer mortality: results of the European Ran-domised Study of Screening for Prostate Cancer (ERSPC) at 13years of follow-up. Lancet, 384 (9959): 2027-35.
13. Leapman MS, Wang R, Park H, et al (2022). Changes in Prostate-Specific Antigen Testing Relative to the Revised US Pre-ventive Services Task Force Recom-mendation on Prostate Cancer Screen-ing. JAMA Oncol, 8 (1): 41-7.
14. Schroder FH, Roobol MJ (2012). Prostate cancer epidemic in sight? Eur Urol, 61 (6): 1093-5.
15. Wilt TJ, Brawer MK, Jones KM, et al (2012). Radical prostatectomy versus observa-tion for localized prostate cancer. N Engl J Med, 367 (3): 203-13.
16. Dickinson J, Shane A, Tonelli M, et al (2016). Trends in prostate cancer inci-dence and mortality in Canada during the era of prostate-specific antigen screening. CMAJ Open, 4 (1): E73-9.
17. Etzioni R, Tsodikov A, Mariotto A, et al (2008). Quantifying the role of PSA screening in the US prostate cancer mortality decline. Cancer Causes Control, 19 (2): 175–81.
18. Murray CJL, Aravkin AY, Zheng P, et al (2020). Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Glob-al Burden of Disease Study 2019. Lancet, 396 (10258): 1223-49.
19. Fitzmaurice C, Abate D, Abbasi N, et al (2019). Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and dis-ability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analy-sis for the Global Burden of Disease Study. JAMA Oncol, 5 (12): 1749-68.
20. Hugosson J, Roobol MJ, Månsson M, et al (2019). A 16-yr Follow-up of the Europe-an Randomized study of Screening for Prostate Cancer. Eur Urol, 76 (1): 43-51.
21. Ilic D, Djulbegovic M, Jung JH, et al (2018). Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ, 362: k3519.
22. Tikkinen KAO, Dahm P, Lytvyn L, et al (2018). Prostate cancer screening with prostate specific antigen (PSA) test: a clinical practice guideline. BMJ, 362: k3581.
23. Shoag JE, Nyame YA, Gulati R, et al (2020). Reconsidering the Tradeoffs of Prostate Cancer Screening. N Engl J Med, 382 (25): 2465–2468.
24. Van Poppel H, Hogenhout R, Albers P, et al (2021). Early detection of prostate can-cer in 2020 and beyond: facts and rec-ommendations for the European Union and the European Commission. Eur Urol, 79 (3): 327–329.
25. Van Poppel H, Roobol MJ, Chandran A (2023). Early Detection of Prostate Can-cer in the European Union: Combining Forces with PRAISE-U. Eur Urol, 84(6): 519-22
26. European Association of Urology. PRAISE-U: Personalised Risk Assessment in Screening Events-UroWeb. Available from: https://uroweb.org/praise-u
27. Kasivisvanathan V, Rannikko AS, Borghi M, et al (2018). PRECISION Study Group Collaborators. MRI-Targeted or Stand-ard Biopsy for Prostate Cancer Diagno-sis. N Engl J Med, 378(19): 1767-77.
28. Mottet N, van den Bergh RCN, Briers E,etal (2021). EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol, 79 (2): 243-62.
29. World Health Organization (2007). Interna-tional Statistical Classification of Dis-eases and Related Health Problems, 10th Revision.
30. Public Health Institute Podgorica (2010). Statistical Yearbook for 2009 on Popula-tion Health and Healthcare in Montene-gro. Podgorica. Printed version.
31. Institute of Public Health of Montenegro. Podaci o mortalitetu 2010-2019. Availa-ble from: https://www.ijzcg.me/me/izvjestaji/umrli-prema-uzroku-smrti-po-grupama-oboljenja-polu-i-starosti-u-crnoj-gori-2010-2019
32. World Health Organization (2001). Age standardization of rates: A new WHO standard. GPE Discussion Paper Series: No.31. https://cdn.who.int/media/docs/default-source/gho-documents/global-health-esti-ma-tes/gpe_discussion_paper_series_paper31_2001_age_standardization_rates.pdf
33. National Cancer Institute (2023). Joinpoint Regression Program, Version 5.0.2-May, 2023. Available from: https://surveillance.cancer.gov/joinpoint/
34. Kim HJ, Fay MP, Feuer EJ, et al (2000). Permutation tests for joinpoint regres-sion with applications to cancer rates. Stat Med, 19 (3): 335-51.
35. Reljić A, Čukelj P, Tomašković I, et al (2018). Epidemiology of Prostate Cancer in Croatia - Situation and Perspectives. Acta Clin Croat, 57(Suppl 1):27-34.
36. Šekerija M, Sekulić K (2016). Trends in prostate cancer incidence (1968-2013) and mortality (1960-2014) in Croatia: A joinpoint regression analysis. ENCR Scientific Meeting and General Assem-bly 2016.
37. Ilic M, Ilic I (2016). Prostate cancer mortali-ty in Serbia, 1991-2010: a joinpoint re-gression analysis. J Public Health (Oxf), 38 (2): e63-7.
38. Wang F, Wang C, Xia H, et al (2022). Bur-den of Prostate Cancer in China, 1990-2019: Findings from the 2019 Global Burden of Disease Study. Front Endocrinol (Lausanne), 13: 853623.
39. Spanjol J, Maricić A, Cicvarić T, et al (2007). Epidemiology of prostate cancer in the mediterranean population of Croatia--a thirty-three year retrospective study. Coll Antropol, 31(1) :235-9.
40. Catalona WJ (2018). Prostate Cancer Screening. Med Clin North Am,102(2): 199-214.
41. Martin RM, Donovan JL, Turner EL, et al (2018). Effect of a Low-Intensity PSA-Based Screening Intervention on Pros-tate Cancer Mortality: The CAP Ran-domized Clinical Trial. JAMA, 319(9): 883-95.
42. U.S. Preventive Services Task Force (2008). Screening for prostate cancer: U.S. Pre-ventive Services Task Force recommen-dation statement. Ann Intern Med, 149:185-91.
43. Moyer VA, U.S. Preventive Services Task Force (2012). Screening for prostate cancer: U.S Preventive Services Task Force recommendation statement. Ann Intern Med, 157 (2): 120–34.
44. Zargar H, van den Bergh R, Moon D, et al (2017). The impact of the United States Preventive Services Task Force (USPTSTF) recommendations against prostate-specific antigen (PSA) testing on PSA testing in Australia. BJU Int, 119 (1): 110–115.
45. de Carvalho TM, Heijnsdijk EAM, de Kon-ing HJ (2018). Comparative effectiveness of prostate cancer screening between the ages of 55 and 69 years followed by active surveillance. Cancer, 124 (3): 507-513.
46. Jemal A, Culp MB, Ma J, et al (2021). Pros-tate Cancer Incidence 5 Years after US Preventive Services Task Force Recom-mendations against Screening. J Natl Cancer Inst, 113 (1): 64–71.
47. Prostate Cancer Working Group of Geni-tourinary Cancer Committee in Chinese Anti-Cancer Association (2017). China consensus of prostate cancer screening. Zhonghua Wai Ke Za Zhi, 55(5):340-342.
48. Grossman DC, Curry SJ, Owens DK, et al (2018). Screening for Prostate Cancer: US Preventive Services Task Force Rec-ommendation Statement. JAMA, 319 (18): 1901– 13.
49. Callender T, Emberton M, Morris S, et al (2021). Benefit, Harm, and Cost-effectiveness Associated With Magnetic Resonance Imaging Before Biopsy in Age-based and Risk-stratified Screening for Prostate Cancer. JAMA Netw Open, 4 (3): e2037657.
50. Talala K, Walter S, Taari K, et al (2024). Screening history and risk of death from prostate cancer:a nested case-control study within the screening arm of the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC). Cancer Causes Control, 35(4):695-703.
51. Negoita S, Feuer EJ, Mariotto A, et al (2018). Annual Report to the Nation on the Status of Cancer, part II: Recent changes in prostate cancer trends and disease characteristics. Cancer, 124 (13): 2801–14.
52. Iser DA, Cobalchini GR, Oliveira MM, et al (2022). Prostate cancer mortality in Brazil 1990-2019: geographical distribu-tion and trends. Rev Soc Bras Med Trop, 55(suppl 1):e0277.
53. Silva GAE, Jardim BC, Ferreira V de M, et al (2020).Cancer mortality in the Capitals and in the interior of Brazil: a four-decade analysis. Rev Saude Publica, 54: 126.
54. Darcey E, Boyle T (2018). Tobacco smok-ing and survival after a prostate cancer diagnosis: A systematic review and meta-analysis. Cancer Treat Rev, 70: 30-40.
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| Issue | Vol 54 No 9 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i9.19858 | |
| Keywords | ||
| Prostate Cancer Joinpoint regression Mortality Montenegro | ||
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How to Cite
1.
Nedovic Vukovic M, Bojic M, Jaksic M, Golubovic M, Vukovic M. Prostate Cancer Mortality Trend in Montenegro 1990-2018. Iran J Public Health. 2025;54(9):1906-1916.
