High prostate cancer mortality in Poland. A spatial, temporal and structural analysis.

Introduction: This study investigates spatial distribution and future trends in prostate cancer mortality in Poland. Since detection of prostate cancer is based on patients’ requests (not an invitation system), hypothesis of self-selection of patients was also verified

Material And Methods: Age-period-cohort model was estimated to assess mortality trends. A spatial analysis was performed by Kulldorff’s and Moran’s tests. Structural equation model was fitted to identify factors influencing decision on participation in prostate cancer screening. Statistical analysis is based on data from the National Cancer Registry for 1980-2014 and a 2014 questionnaire survey of 1,700 men aged 45+.

Results: The annual number of registered deaths due to prostate cancer is expected to increase from 4,440 in 2014 to 6,550 in 2030. Prostate cancer mortality in Poland is to a large extent spatially uniform (global Moran’s Ig=0.066) and was not found to be related to spatial patterns in oral contraceptive use in women which was recently hypothesised. Nevertheless, a Kulldorff’s cluster can be identified over the Lubusz and Greater Poland areas for both the 1980-1984 and the 2010-2014 periods (p<0.001). The structural equation model showed that the early detection of prostate cancer is influenced mainly by physician’s activeness and local availability of healthcare (p<0.050). The direct effect of socio-economic status on early detection of prostate cancer is insignificant.

Conclusions: When considering prediction results, one should request more actions aimed at facing the upward trend of deaths, including making research funding in prostate cancer a priority, improving understanding of prostate cancer among males, and offering to patients individualised risk-adapted strategy modelled on the guidelines of the European Association of Urology. Currently, uptake of prostate cancer screening is largely affected by external factors.