Future burden of prostate cancer mortality in Brazil: a population-based study Projeções de mortalidade por câncer de próstata no Brasil: um estudo de base populacional Proyecciones de mortalidad por cáncer de próstata en Brasil: un estudio de base poblacional

Prostate cancer mortality projections at the nationwide and regional levels to the year 2025 are carried out in this ecological study that is based on an analysis of Brazilian trends between 1996 and 2010. The predictions were made for the period 2011-2025 utilizing the Nordpred program based on the period of 1996-2010, using the ageperiod-cohort model. A significant increase was observed in the Brazilian rates between 1996 and 2006, followed by a non-significant decrease. The projections indicate a decrease in rates at a national level as well as for the Central, South and Southeast regions. Increases are expected for the North and Northeast regions. In conclusion, a reduction in the mortality rates for prostate cancer in Brazil is expected to the year 2025, as well as for the Central, South and Southeast regions. However, an increase in the absolute number of deaths in all regions is expected due to the anticipated aging of the population. Prostatic Neoplasms; Mortality; Population Studies in Public Health Resumo Este estudo ecológico realiza projeções de mortalidade por câncer de próstata no Brasil e suas regiões até o ano 2025, com base nas tendências observadas no período de 1996 a 2010. As projeções foram realizadas para o período 2011-2025 mediante o programa Nordpred, baseado no período 1996-2010, usando o modelo idade-período-coorte. Observou-se um aumento significativo das taxas no Brasil entre 1996 e 2006, seguido de um descenso não significativo. As projeções indicam uma diminuição das taxas em nível nacional e nas regiões Centro-oeste, Sul e Sudeste, enquanto nas regiões Norte e Nordeste se espera um incremento das taxas. É esperada uma redução das taxas de mortalidade por câncer de próstata até o ano 2025 no Brasil em conjunto, assim como nas regiões Centro-oeste, e Sul e Sudeste, e um incremento nas regiões Norte e Nordeste. Contudo, prevê-se um aumento do número absoluto de mortes pela doença em todas as regiões devido ao envelhecimento populacional previsto no país. Neoplasias da Próstata; Mortalidade; Estudos Populacionais em Saúde Pública 2451 ARTIGO ARTICLE http://dx.doi.org/10.1590/0102-311X00007314 Jerez-Roig J et al. 2452 Cad. Saúde Pública, Rio de Janeiro, 30(11):2451-2458, nov, 2014 Introduction Prostate cancer is considered globally to be the most prevalent and the sixth most mortal type of cancer in men. In Brazil, prostate cancer is the most common type of cancer in men and, in terms of the number of deaths, occupies second position, after lung cancer. The incidence rate is approximately 50 per 100,000 inhabitants, with more than 40,000 cases diagnosed annually. 14,500 deaths by prostate cancer are registered every year in Brazil, with rates of 16 deaths per 100,000 inhabitants per year, slightly fewer than lung cancer 1. It has been observed that prostate cancer mortality rates have not increased at the same rate as incidence rates, probably due to improvements in treatment associated with diagnosis measures 2. The prostate-specific antigen (PSA) test was responsible, principally after the 1980s, for causing increases in incidence and survival rates for prostate cancer, as a consequence of early diagnosis 3,4. However, the prevalence of PSA testing is relatively low in less developed countries, where Western influenced lifestyles have caused increases in prostate cancer rates 5. In the case of Brazil, the adjusted mortality rates increased by approximately 70% from the early 1980s to the start of the 21st century 6. The International Agency for Research on Cancer (IARC) predicts that the number of deaths by prostate cancer in Brazil will almost double by the year 2025 1. However, these projections are limited, as there are no ageor regionspecific data available. The detailed study presented herein is very important in a country with a high proportion of inequalities and profound regional differences such as Brazil. Furthermore, trend analysis and cancer mortality projections are very useful for planned interventions such as screening programs and therapy advances, as well as to quantify the probable burden of cancer in the future. The objective of this study is to carry out projections of prostate cancer mortality in Brazil and its regions until the year 2025, based on the trend analysis for the period 1996-2010.