J Urol Oncol > Volume 21(1); 2023 > Article
Han and Yuk: Epidemiology of Urologic Cancer in Korea: Nationwide Trends in the Last 2 Decades

Abstract

Purpose

This study assessed recent trends in the incidence of urologic cancer and patient survival in Korea.

Materials and Methods

The incidence of urologic cancer in Korea was calculated based on the Korea National Cancer Incidence Database and the South Korean Statistical Information Service Database. Data from 2000 to 2020 were used to determine the incidence, death, prevalence, and survival rates of urologic cancer.

Results

Urologic cancer was diagnosed in 27,514 cases, accounting for 11.1% of the total cancer incidence. In 2020, there were 16,815 prostate cancer cases, 5,946 kidney cancer cases, and 4,753 bladder cancer cases. The age-standardized rate (ASR) for the incidence of prostate, kidney, and bladder cancer increased from 2000 to 2020. The overall ASR was 56 per 100,000 in 2020. In 2000, the ASRs for prostate, kidney, and bladder cancer were 2.9, 3.1, and 4.8 per 100,000, respectively, whereas they were 32.7, 11.6, and 9.3 per 100,000, respectively, in 2020. Urologic cancer has also seen a steady increase in the death rate, prevalence rate, and relative survival rate over the past 20 years. The 5-year relative survival rates for patients diagnosed with prostate cancer, kidney cancer, and bladder cancer during the 5-year period from 2015 to 2019 were 94.4%, 84.7%, and 76.5%, respectively. Among urologic cancers, prostate cancer had the highest survival rate, and bladder cancer had the lowest.

Conclusions

The survival rate for urologic cancer is increasing; however, the incidence and prevalence rates continue to rise.

INTRODUCTION

Cancer is one of the leading causes of death worldwide [1]. According to World Health Organization estimates, there were approximately 19.3 million new cases and 10 million deaths from cancer worldwide in 2020 [1]. In addition, a report on global cancer statistics estimated that one in 5 people may experience cancer and 1 in 6 people will die from cancer [1,2]. Cancer is a major public health problem worldwide, constituting the second leading cause of death in the United States and the leading cause of death in Korea [2,3]. According to recent cancer statistics, 247,952 new cancers and 83,776 cancer-related deaths occurred in Korea in 2020 [3]. Furthermore, cancer incidence and death rates are increasing worldwide, and the burden of disease is rapidly increasing [4,5]. These increases are related to changes in population growth, aging, and socioeconomic development [4-6]. Korea is also experiencing an increase in the older population owing to economic development, westernization, and rapid aging [7]. Urologic cancers are among those most closely related to this increase in the older population [1]. The incidence of urologic cancer in Korea has been steadily increasing due to the rapid increase in the older population, which is expected to continue in the future [7]. However, despite the known increase in the number of urologic cancer patients, data related to the epidemiological statistics of urologic cancer in Korea are very limited.
In this study, we report the most recent national statistics on the incidence, survival, prevalence, and death rates, as well as temporal trends, using national epidemiological data for prostate, kidney, and bladder cancers, the 3 most common urologic cancers in Korea.

MATERIALS AND METHODS

1. Data Sources

For annual statistics of urologic cancer, the Korea National Cancer Incidence Database (KNCI DB) [8] and the Korean Statistical Information Service Database data provided by the National Statistical Office of Korea were used [9].
The KNCI DB is a national, population-based database of cancer incidence that is currently used to calculate the National Cancer Registry statistics, which are published annually for data collection and refinement [8].
All carcinomas classified as malignant according to the International Classification of Diseases for Oncology, third edition and the International Classification of Diseases, 10th revision (ICD-10) were included in the analysis and then classified according to 24 carcinoma classifications, modified based on the carcinoma classification used by the International Agency for Research on Cancer [10].

2. Statistical Analysis

Data from 2000 to 2020 were used to determine the incidence and death rates of cancer. In the prevalence, data collection began in 2007 and continued until 2019. Therefore, unlike incidence and mortality, the data spanning from 2007 to 2019 was analyzed and presented. The survival rate was analyzed using data from 2001 to 2019. Data from the National Statistical Office were used to determine whether death had occurred, and the cause of death was coded and classified according to the ICD-10.
The cancer sites were classified as follows: prostate (C61), kidney (C64), and bladder (C67). To determine trends in urologic cancer incidence, the incidence, prevalence, and death rate rates were calculated per 100,000 people (crude rates [CRs]) and age-standardized rates (ASRs) based on the world standard population.
The CRs were calculated as the total number of incidence (crude incidence rate [CIR]), death rate (crude death rate [CDR]), or prevalence (crude prevalence rate [CPR]) cases divided by the annual population per year.
The ASR was standardized using the 2000 registered population and expressed per 100,000 people. In addition, to determine the distribution of urologic cancers according to age, cancer statistics from 2000 to 2020 were used to classify the total number of urologic cancers by age group.

RESULTS

1. Incidence Rate

The number of cancer cases in Korea increased by approximately 2.5 times, from 101,032 in 2000 to 247,952 in 2020. The 3 representative types of urologic cancer are kidney cancer, bladder cancer, and prostate cancer. In 2000, there were 1,455 prostate cancer cases, 979 kidney cancer cancers, and 1,744 bladder cancer cases, totaling 4,178 cases, corresponding to approximately 4.1% of the total cancer incidence rate. In 2020, there were 16,815 prostate cancer cases, 5,946 kidney cancer cases, and 4,753 bladder cancer cases, totaling 27,514 cases, accounting for 11.1% of the total cancer incidence; this number increased by 2.7 times (Table 1).
Table 1.
Trends in the incidence, death rate, and the mortality-to-incidence ratio of urologic cancer from 2000 to 2020 in Korea in both sexes
Variable 2000 2005 2010 2015 2020
Incidence (ASR)
    Total 5,091 (10.7) 9,206 (18.9) 15,430 (30.9) 19,175 (37.6) 27,514 (53.6)
    Men 4,167 (17.4) 7,837 (32.1) 13,634 (54.6) 17,518 (68.8) 24,776 (96.7)
    Women 924 (3.9) 1,369 (5.6) 1,796 (7.2) 2,257 (8.8) 2,738 (10.6)
Deaths (ASR)
    Total 1,843 (3.9) 2,475 (5.2) 3,225 (6.5) 3,951 (7.7) 4,863 (9.5)
    Men 1,483 (6.2) 2,033 (8.3) 2,712 (10.9) 3,332 (13.1) 4,193 (16.4)
    Women 360 (1.5) 442 (1.9) 513 (2.0) 619 (2.4) 670 (2.6)
M/I ratio (%)
    Total 36.2 26.9 20.9 20.6 17.7
    Men 35.6 25.9 19.9 19.0 16.9
    Women 39 32.3 28.6 27.4 24.5

Values are presented as number (%) unless otherwise indicated.

ASR, age-standardized rate per 100,000; M/I ratio, morality/incidence rate ratio.

Regionally, the incidence was highest in Seoul, Gyeonggi Province, and cities with relatively large populations (Fig. 1, Supplementary Table 1).
Fig. 1.
Incidence map of prostate cancer (A), kidney cancer (B), and bladder cancer (C) by region.
juo-21-1-32f1.jpg
In 2020, the CIR and ASR of overall urologic cancer incidence were 53.6 per 100,000 (96.7 for men, 10.6 for women) and 56 per 100,000 (106.9 for men, 10.1 for women), respectively. (Table 2, Supplementary Table 2). The difference between the CIR and ASR values can be explained by the fact that the majority of urologic cancer patients are older individuals, while the global standard population has a high proportion of young people.
Table 2.
Trends in age-standardized incidence rate of urologic cancer from 2000 to 2020 in Korea in both sexes
Variable 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Prostate 6.6 8.7 9.5 11.3 13.5 14.3 16.4 19.1 21.6 23.4 24.3 26.0 25.8 25.3 25 24.9 27.7 28.8 31.8 34.5 32.7
Kidney 5.2 5.8 6.1 6.2 6.6 7.5 7.9 8.6 9.1 9.5 9.6 10.1 10.3 10.3 10.5 10.3 11.0 11.4 11.3 12.1 11.6
    Male 8.2 8.8 9.2 9.5 10.3 11.5 11.9 13.1 13.8 14.1 14.7 15.2 15.5 15.5 15.8 15.3 15.9 16.5 16.8 17.6 16.9
    Female 3.0 3.4 3.6 3.6 3.9 4.4 4.6 4.9 5.2 5.8 5.4 6.0 6.0 6.1 6.1 6.1 6.5 6.7 6.5 7.2 6.7
Bladder 9.8 10.5 10.2 10.6 10.9 11.0 10.8 10.8 10.7 10.3 10.5 10.5 9.9 10.1 10.2 9.8 10.2 9.9 9.9 10.0 9.3
    Male 19.7 20.7 20.0 21.1 21.3 21.9 21.8 21.1 21.0 20.1 20.5 20.6 19.5 19.6 19.8 19.1 19.6 18.9 18.6 19.2 17.4
    Female 3.5 3.9 3.8 3.8 3.8 3.8 3.6 3.9 3.7 3.6 3.6 3.6 3.3 3.4 3.4 3.4 3.6 3.4 3.5 3.3 3.2
The ASR for the incidence of prostate, kidney, and bladder cancer increased from 2000 to 2020. This increase was relatively gradual for kidney and bladder cancers, whereas the incidence of prostate cancer has increased rapidly since 2005, and it has had the highest ASR among urologic cancers since 2003 (Fig. 2).
Fig. 2.
Trends in the age-standardized incidence rate of urologic cancer from 2000 to 2020 in Korea, Urologic cancer (A), kidney cancer by sex (B), and bladder cancer by sex (C).
juo-21-1-32f2.jpg
The incidence of kidney and bladder cancers was higher in men than in women. However, the annual percent change (APC) pattern of cancer incidence and death showed a greater change in women than in men. In kidney cancer, the APC increased more in women than in men (4.3% vs. 3.8%, respectively), and in bladder cancer, the APC decreased more in women than in men (-0.7% vs. -0.3%, respectively).

1) Incidence rate of prostate cancer

In 2000, there were 1,455 prostate cancer cases, while there were 16,815 cases in 2020—an approximately 11-fold increase. In 2000, the incidence of prostate cancer was lower than that of kidney and bladder cancers. However, it surpassed kidney cancer in 2001 and bladder cancer in 2004, becoming the most common urologic cancer. Since 2008, its incidence has been higher than that of bladder and kidney cancer (upplementary Table 2).
The ASR showed a similar pattern. In 2000, the ASR was 2.9 per 100,000 people, while it was 32.7 per 100,000 people in 2020, an approximately 11-fold increase. In 2000, the incidence of prostate cancer was lower than that of kidney cancer (ASR, 3.1 per 100,000) and bladder cancer (ASR, 4.8 per 100,000), but it surpassed the ASR of kidney cancer in 2001 and bladder cancer in 2004 and 2008. The ASR of prostate cancer became approximately 2 times as high as those for the incidence of kidney and bladder cancer by 2018, and by 2020, it exceeded the ASRs for kidney and bladder cancer by roughly 3-fold (Table 2).
In an analysis of the incidence rate of prostate cancer by age using 2020 data, the incidence rate increased rapidly from the age of 50 years to peak at the ages of 75-79 years. Meanwhile, the ASR was 0.1 per 100,000 individuals in their 20s (Fig. 3, Supplementary Table 3).
Fig. 3.
Trends in the age-standardized incidence rate of urologic cancer by age from 2000 to 2020 in Korea. Prostate cancer (A), kidney cancer (B), and bladder cancer (C).
juo-21-1-32f3.jpg

2) Incidence rate of kidney cancer

In 2000, there were 979 cases of kidney cancer, while there were 5,946 cases in 2020—a 6-fold increase. Furthermore, it occurred more than twice as often in men than in women. In 2020, there were more cases of prostate cancer than of bladder cancer. In 2009, bladder cancer was the second most common cancer of the urinary system worldwide. Unlike prostate cancer, which has increased rapidly, kidney cancer showed a gradually increasing incidence pattern, similar to that of bladder cancer (Supplementary Table 2).
In 2000, the ASR was 3.1 per 100,000 people, while it was 11.6 per 100,000 people in 2020, corresponding to an increase of approximately 3.7 times. In 2000, the incidence of kidney cancer was lower than that of bladder cancer (ASR, 4.8 per 100,000 people), but in 2009, it rose higher than the ASR of bladder cancer, showing a consistently high ASR until 2020 (Table 2).
In 2000, the ASR for incidence in men was 8.2 per 100,000, whereas it was 3 per 100,000 in women, showing a 2.7 times higher incidence rate in men than in women. In 2020, the ASR in men was 16.9 per 100,000, while that in women was 6.7 per 100,000, both reflecting more than a 2-fold increase since 2000 (Fig. 2, Supplementary Table 4).
An analysis of the incidence rate of kidney cancer by age using 2020 data showed that the incidence rate increased rapidly from the age of 40 years onward, peaking at the ages of 70-74. When analyzing men and women separately, the rate for men increased rapidly starting at the age of 35
years and reached a peak at the ages of 70-74, while that for women started increasing rapidly at the age of ≥50 years and peaked at the ages of 75-79 (Fig. 3, Supplementary Table 3).

3) Incidence rate of bladder cancer

In 2000, 1,744 cases of bladder cancer were reported, while there were 4,753 cases in 2020—an increase of approximately 2.7 times. Bladder cancer is 5 times more common in men than in women. In 2000, more cases of bladder cancer were observed than of other types of urologic cancer, but in 2020, bladder cancer occurred in fewer cases than prostate and kidney cancer. Unlike prostate cancer, which increased rapidly, bladder cancer showed a gradually increasing incidence pattern, similar to that of kidney cancer (Supplementary Table 2).
In 2000, the ASR was 4.8 per 100,000 people, but it increased to 9.3 per 100,000 people in 2020, approximately doubling. In 2000, the incidence of bladder cancer was higher than that of prostate cancer (ASR, 2.9 per 100,000 people) and kidney cancer (ASR, 3.1 per 100,000 people) (Table 2).
In 2000, the ASR for incidence in men was 19.7 per 100,000, while it was 3.5 per 100,000 in women, indicating a 5.6 times higher incidence rate in men than in women. In 2005, the ASR in men peaked at 21.9 per 100,000, while the ASR in women peaked at 3.9 per 100,000 in 2007; by 2020, the ASR had decreased to 17.4 per 100,000 in men and 3.2 per 100,000 in women. These findings show a clear trend. Compared to 2000, the ASR of bladder cancer in 2020 was slightly lower in both men and women (Fig. 2).
An analysis of the incidence rate of bladder cancer by age using data from 2020 showed that the incidence rate increased rapidly after the age of 50 years and peaked at the age of 80-84 years. In men, it increased rapidly from the age of 50 years and continued to rise until the age of ≥85 years, while in women, it increased rapidly from the age of ≥65 years and continued to rise until ≥85 years of age (Fig. 3, Supplementary Table 4).

2. Death Rate

The number of all cancer deaths in Korea totaled 59,117 in 2000, and the CDR was 124.5 per 100,000 people. In 2020, there were a total of 83,776 cancer deaths, and the CDR was 164.3 people per 100,000 people. In 2000, there were 548 deaths from prostate cancer, 517 from kidney cancer, and 778 from bladder cancer, totaling 1,843, which corresponded to approximately 3.1% of the total cancer death rate. The CDRs for prostate, kidney, and bladder cancer were 1.2, 1.1, and 1.6 per 100,000 people, respectively. In 2020, there were 2,194 deaths from prostate cancer, 1,076 deaths from kidney cancer, and 1,593 deaths from bladder cancer. These figures correspond to 5.8% of all cancer deaths, and the number of deaths has increased by approximately 2-fold compared to that in 2000. The CDRs for prostate, kidney, and bladder cancer were 4.6, 2, and 3 per 100,000 people, respectively. Compared to 2020, the number of deaths from prostate cancer increased by approximately 4 times, and the number of deaths from kidney and bladder cancer roughly doubled (Table 3).
Table 3.
Trends in the crude death rate of urologic cancer from 2000 to 2020 in Korea in both sexes
Variable 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Prostate 1.2 1.3 1.5 1.6 1.9 1.9 2.1 2.3 2.4 2.5 2.7 2.8 2.9 3.2 3.3 3.3 3.4 3.6 3.9 4.0 4.3
Kidney 1.1 1.1 1.2 1.3 1.2 1.4 1.4 1.5 1.3 1.5 1.6 1.7 1.8 1.9 1.9 1.9 2.0 2.0 1.9 1.9 2.1
    Male 1.4 1.5 1.6 1.8 1.7 1.8 2.0 1.9 1.9 2.0 2.3 2.3 2.6 2.6 2.6 2.6 2.8 2.7 2.6 2.6 3.0
    Female 0.7 0.6 0.8 0.8 0.7 0.9 0.8 1.0 0.8 1.0 0.9 1.0 1.0 1.1 1.1 1.1 1.2 1.2 1.2 1.2 1.2
Bladder 1.6 1.7 1.9 2.0 1.8 1.9 1.9 1.9 2.0 1.9 2.2 2.3 2.4 2.5 2.7 2.5 2.7 2.8 2.7 3.0 3.1
    Male 2.5 2.4 3.0 2.9 2.7 2.8 2.9 2.9 3.0 2.9 3.3 3.4 3.6 3.9 4.0 3.8 4.0 4.3 4.1 4.6 4.8
    Female 0.8 1.0 0.9 1.0 0.9 1.0 0.9 1.0 1.0 1.0 1.1 1.3 1.2 1.2 1.3 1.3 1.4 1.3 1.3 1.5 1.4
In men, the CDR in 2000 was 2.3 per 100,000 men for prostate cancer, 1.4 for kidney cancer, and 2.5 for bladder cancer, whereas in 2020, the CDR per 100,000 men was 9.2 for prostate cancer, 2.8 for kidney cancer, and 4.5 for bladder cancer. The CDR for prostate cancer increased by about 4 times, that of kidney cancer roughly doubled, and that of bladder cancer increased by about 1.8 times (Table 3).
In women, the CDR in 2000, the CDR was 0.7 per 100,000 women for kidney cancer and 0.8 for bladder cancer; by 2020, the CDR increased to 1.2 per 100,000 women for kidney cancer and 1.5 per 100,000 women for bladder cancer, corresponding to an increase by about 1.7 times for kidney cancer and 1.9 times for bladder cancer. Men had higher death rates than women due to kidney and bladder cancer (Table 3).

1) Death rate associated with prostate cancer

The number of deaths due to prostate cancer quadrupled from 548 in 2000 to 2,194 in 2020. In 2000, the number of deaths from prostate cancer was higher than that from kidney cancer and lower than that from bladder cancer. However, since 2006, it has outpaced bladder cancer deaths and has been the leading cause of urologic cancer deaths.
The CDR followed a similar pattern. In 2000, the CDR was 1.2 per 100,000 people, and in 2020, it was 4.3 per 100,000 people—an increase of approximately 3.5 times. In 2000, the death rate of prostate cancer was higher than that of kidney cancer (CDR, 1.1 per 100,000 people) and lower than that of bladder cancer (CDR, 1.6 per 100,000 people). In 2020, it had the highest death rate among urologic cancers, with approximately 2 times the CDR of kidney cancer and 1.4 times the CDR of bladder cancer (Fig. 4, Supplementary Table 5).
Fig. 4.
Trends in the crude death rate of urologic cancer from 2000 to 2020 in Korea. Urologic cancer (A), kidney cancer by sex (B), and bladder cancer by sex (C).
juo-21-1-32f4.jpg
In an analysis of the death rate of prostate cancer by age using 2020 data, the death rate increased rapidly from the age of 70 years and peaks at the ages of 85-89 years. In addition, the CDR was 0.2 per 100,000 people in the 50-54 years age range (Fig. 5).
Fig. 5.
Trends in the crude death rate of urologic cancer by age from 2000 to 2020 in Korea. Prostate cancer (A), kidney cancer (B), and bladder cancer (C).
juo-21-1-32f5.jpg

2) Death rate associated with kidney cancer

The number of deaths from kidney cancer doubled from 517 in 2000 to 1,076 in 2020, with twice as many deaths in men as in women. In both 2000 and 2020, kidney cancer had the lowest number of deaths among urologic cancers. Compared to 2000, the number of deaths in 2020 showed an increase, but this increase was relatively modest compared to the other types of urologic cancer.
In 2000, the CDR of kidney cancer was 1.1 per 100,000 people, and in 2020, it was 2.1 per 100,000 people—an increase of approximately 1.9 times. In 2000, the death rate of kidney cancer was lower than that of prostate cancer (CDR, 1.2 per 100,000 people) and bladder cancer (CDR, 1.6 per 100,000 people) (Fig. 4).
In 2000, the CDR in men was 1.4 per 100,000 people, while that in women was 0.7 per 100,000 people, showing a death rate twice as high for men than for women. In 2020, the CDR in men was 3 per 100,000, while that in women was 1.2 per 100,000; both of these rates more than doubled from 2000, and the death rate for men was approximately 3.6 times higher than that of women (Fig. 4).
An analysis of the death rate of kidney cancer by age using data from 2020 showed that the incidence rate increased rapidly after the age of 70 years and peaked at the ages of 85-89. The rate for men increased rapidly starting at the age of 65 and continued to rise until after the age of 90, while that for women increased rapidly at ≥60 years of age, peaking at the ages of 85-89 (Fig. 5).

3) Death rate associated with bladder cancer

The number of deaths from bladder cancer doubled from 778 in 2000 to 1,593 in 2020, with 3 times more deaths in men than in women. In 2000, bladder cancer accounted for the highest number of deaths among urologic cancers, whereas in 2020, it caused the second-highest number of deaths. The number of deaths gradually increased.
In 2000, the CDR was 1.6 per 100,000 people, while it was 3.1 per 100,000 people in 2020—an increase of approximately 1.9 times. In 2000, the death rate of bladder cancer was higher than that of prostate cancer (CDR, 1.2 per 100,000 people) and kidney cancer (CDR, 1.1 per 100,000 people) (Fig. 4).
In 2000, the CDR in men was 2.5 per 100,000 people, while that in women was 0.8 per 100,000 people, showing a death rate about 3.1 times higher for men than for women. In 2020, the CDR in men was 4.8 per 100,000 people and that for women was 1.4 per 100,000 people. Compared to 2000, the CDR increased by approximately 1.9 times for men and 1.7 times for women (Fig. 4).
In an analysis of the death rate of bladder cancer by age using data from 2020, the incidence rate increased rapidly from the age of 70 years and continued to rise until ≥90 years of age. The death rate for men increased rapidly from the age of ≥65 years and continued to rise until ≥90 years of age; for women, it increased rapidly from the age of ≥75 years and continued to rise until ≥90 years of age (Fig. 5).

3. Prevalence Rate

The total number of cancer patients in 2020 in Korea was 2,276,792; this number has continued to increase since it exceeded 2 million in 2018. The prevalence of cancer in Korea in 2020 was 4,433.9 per 100,000 people.
In 2020, the prevalence of urologic cancer was 120,423 for prostate cancer, 54,652 for kidney cancer, and 41,835 for bladder cancer, corresponding to rates of 442.4 per 100,000 people for urologic cancer and 234.5, 106.4, and 81.5 per 100,000 people for prostate, kidney, and bladder cancer, respectively.

1) Prevalence rate of prostate cancer

The prevalence of prostate cancer increased by approximately 3.6 times, from 16,549 in 2007 to 60,347 in 2019 (Supplementary Table 6). The prevalence of prostate cancer in 2007 was higher than that of kidney or bladder cancer and remained high through 2019 (Fig. 6).
Fig. 6.
Trends in the age-standardized prevalence rate of urologic cancer from 2007 to 2019 in Korea. Urologic cancer (A), kidney cancer by sex (B), and bladder cancer by sex (C).
juo-21-1-32f6.jpg
The CPR and ASR for prevalence followed a similar pattern. In 2007, the CPR was 33.7 per 100,000 people, while it was 117.5 per 100,000 people in 2019—an increase of approximately 3.5 times. (Supplementary Table 7). In 2007, the ASR was 25.3 per 100,000 people, while it was 54.3 per 100,000 people in 2019, corresponding to an increase of approximately 2.1 times. In 2007 (Table 4), the prevalence of prostate cancer was higher than that of kidney cancer (CPR, 19.1 per 100,000 people) and bladder cancer (CPR, 23.5 per 100,000 people); in 2019, it was approximately 2.6 times higher than the CPR for kidney cancer and 3.5 times higher than the CPR for bladder cancer. Prostate cancer has the highest prevalence of all urologic cancers (Fig. 6). An analysis of the prevalence of prostate cancer by age from 2007 to 2019 showed that it increased rapidly after the age of 50 and peaked at the ages of 70-79. Since 2007, the prevalence of prostate cancer increased in all age groups >50 years (Fig. 7, Supplementary Table 8).
Table 4.
Trends in the age-standardized prevalence rate of urologic cancer from 2007 to 2019 in Korea in both sexes
Variable 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Prostate 25.3 29.6 33.6 37.6 41.5 43.8 45.1 45.7 46.0 47.0 48.2 50.7 54.3
Kidney 15.7 17.2 18.5 19.7 20.9 21.9 22.8 23.4 23.9 24.5 25.3 26.0 27.4
    Male 22.9 25.0 26.9 28.7 30.3 31.7 32.9 34.0 34.3 35.2 36.1 37.4 39.1
    Female 9.5 10.4 11.2 11.8 12.7 13.2 13.7 13.9 14.2 14.6 15.2 15.4 16.3
Bladder 18.1 17.8 17.2 30.2 31.3 32.1 32.9 32.8 34.5 35.2 40.4 35.9 36.4
    Male 35.1 34.7 33.9 33.6 33.0 32.0 31.6 31.5 31.1 30.9 30.6 30.1 29.8
    Female 5.9 5.8 5.7 5.5 5.3 5.2 5.1 5.0 5.1 5.2 5.2 5.3 5.3
Fig. 7.
Trends in the age-standardized prevalence rate of urologic cancer by age from 2007 to 2019 in Korea. Prostate cancer (A), kidney cancer (B), and bladder cancer (C).
juo-21-1-32f7.jpg

2) Prevalence rate of kidney cancer

The prevalence of kidney cancer increased by approximately 2.4 times, from 9,382 in 2007 to 22,817 in 2019. In 2007, the prevalence of prostate cancer was lower than that of kidney or bladder cancer, but it became higher than that of bladder cancer in 2010 and showed a consistently high prevalence until 2019.
The CPR followed a similar pattern. In 2007, the CPR was 19.1 per 100,000 people, while it was 44.4 per 100,000 people in 2019—an increase of about 2.3 times. In 2007, the prevalence of kidney cancer was lower than that of prostate cancer (CPR, 33.7 per 100,000 people) and bladder cancer (CPR, 23.5 per 100,000 people). It consistently showed a higher prevalence than bladder cancer.
In 2007, the CPR in men was 25.9 per 100,000 people, while in women it was 12.2 per 100,000 people, showing a 2.1 times higher prevalence in men than in women. In 2019, the CPR in men was 61.2 per 100,000 people and the CPR in women was 27.5 per 100,000 people, both more than double the corresponding rates in 2007. The prevalence rate in men was approximately 2.2 times higher than that in women.
An analysis of the prevalence of kidney cancer by age from 2007 to 2019 showed that it increased rapidly after ≥30 years of age and peaked at the ages of 70-74. Since 2007, the prevalence of kidney cancer has increased in all age groups >30 years (Fig. 7).

3) Prevalence rate of bladder cancer

The prevalence of bladder cancer increased by approximately 1.5 times, from 11,535 in 2007 to 17,376 in 2019. In 2007, the prevalence of bladder cancer was lower than that of prostate cancer, but higher than that of kidney cancer; it was lower than that of kidney cancer in 2010 and showed the lowest prevalence among urologic cancers until 2019 (Supplementary Table 6).
The CPR followed a similar pattern. In 2007, the CPR was 23.5 per 100,000 people, while it was 33.8 per 100,000 people—an increase of about 1.4 times. In 2007, the prevalence of bladder cancer was lower than that of prostate cancer (CPR, 33.7 per 100,000 people) and higher than that of kidney cancer (CPR, 19.1 per 100,000 people). In 2019, the CPR was 25.4 per 100,000 people, which was lower than that of kidney cancer (CPR, 26 per 100,000 people) (Supplementary Table 7).
In 2007, the CPR in men was 38.1 per 100,000 people, while that in women was 8.8 per 100,000 people, showing a 4.3 times higher prevalence in men than in women. In 2019, the CPR in men was 55.6 per 100,000 people, and the CPR in women was 12.2 per 100,000 people, both approximately 1.4 times higher than in 2007; the prevalence in men was approximately 4.5 times higher than that in women (Supplementary Table 7).
In 2007, the ASR for prevalence was 18.1 per 100,000 people, while it was 36.4 per 100,000 people—an increase of about 2 times. In 2007, the prevalence of bladder cancer was lower than that of prostate cancer (ASR, 25.3 per 100,000 people) and higher than that of kidney cancer (ASR, 15.7 per 100,000 people). In 2019, the ASR was 36.4 per 100,000 people, which was higher than that of kidney cancer (CPR, 27.4 per 100,000 people) (Table 4).
In 2007, the ASR for prevalence in men was 35.1 per 100,000 people, while it was 5.9 per 100,000 people in women, showing a prevalence 5.9 times higher in men than in women. In 2019, the ASR in men was 29.8 per 100,000 people and 5.3 per 100,000 people in women. Both of these rates were lower than in 2007, and the prevalence in men was approximately 5.6 times higher than that in women (Table 4).
An analysis of the prevalence of bladder cancer by age from 2007 to 2019 showed that it increased rapidly after the age of 40 and peaked at the ages of 80-84. Since 2007, there has been no major increase in the prevalence of bladder cancer in any age group, but it tended to increase in those >75 years of age (Fig. 7).

4. Survival Rate

Over the past 20 years, the relative survival rates of patients with cancer have increased significantly and steadily. The 5-year relative survival rate for all patients diagnosed with cancer during the 5-year period from 2015 to 2019 was 70.7%; the sex-specific rates were 64.5% in men and 77.3% in women.
Urologic cancer has also seen a steady increase in relative survival rates over the past 20 years. The relative survival rates between 1993 and 1995 were 59.1%, 64.2%, and 70.7% for prostate, kidney, and bladder cancer, respectively (Fig. 8). The 5-year relative survival rates for patients diagnosed with prostate cancer, kidney cancer, and bladder cancer during the 5-year period from 2015 to 2019 were 94.4%, 84.7%, and 76.5%, respectively (Fig. 8). Among urologic cancers, prostate cancer had the highest survival rate and bladder cancer had the lowest.
Fig. 8.
Trends in the 5-year relative survival rates of urologic cancer from 2001 to 2019 in Korea. Urologic cancer (A), kidney cancer by sex (B), and bladder cancer by sex (C).
juo-21-1-32f8.jpg
The relative survival rate of kidney cancer showed little difference by sex, with 84.7% for men and 84.8% for women. For bladder cancer, men had a higher relative survival rate than women (78.1% vs. 70%, respectively) (Supplementary Table 9).

DISCUSSION

The significance of this study is that it describes the nationwide cancer incidence, mortality, and prevalence of urologic cancer from 2000 to 2020 in Korea. The prostate, kidney, and bladder represent the most common primary sites of urologic cancer in Korea. Compared to the cancer incidence rate reported in GLOBOCAN 2020, the overall ASR of Korean men for prostate cancer is higher than the global average (ASR, 32.7 vs. 30.7 per 100,000 people) and similar to that reported in Western Africa (ASR, 33.1 per 100,000 people) [1]. The prostate cancer death rate is lower than the global average (ASR, 4.3 vs. 7.7 per 100,000 people) and lower than the Eastern Asian average (ASR, 4.7 per 100,000 people). The incidence rate of prostate cancer changed in the late 2000s in Northern and Western Europe, with a decrease in the incidence due to the limited use of prostate-specific antigen (PSA) tests. A similar, albeit less distinct, pattern was also observed in South America, Central America, and Asia. However, cases in Korea have continued to increase, similar to China or Eastern European countries [11-13]. Prostate cancer mortality has declined since the mid-1990s in developed countries such as those in North America, Northern and Western Europe, and Oceania [11,14,15], which likely reflects early detection through increased screening and advances in early-stage treatment and treatment technology [16,17]. However, in Korea, the mortality rate has continued to rise. Similarly, there the mortality rate has increased in Central and Eastern Europe, Asia, and Africa, likely reflecting the continued increase in incidence in these regions and the increasing effectiveness of screening tests such as PSA testing [16,17].
The incidence of kidney cancer in Korean men is higher than the global average (ASR, 8.2 vs. 6.1 per 100,000 people). The death rate in Korean men is also higher than the global average (ASR, 3.0 vs. 2.5 per 100,000 people). The incidence of kidney cancer in Korean women is also higher than the global average (ASR, 6.7 vs. 3.2 per 100,000 people). However, the death rate for Korean women was the same as the world average (ASR, 1.2 vs. 1.2 per 100,000 people).
The incidence of bladder cancer in Korean men is also higher than the world average (ASR, 17.4 vs. 9.5 per 100,000 people). It is similar to that of North America (ASR, 18.1 per 100,000 people). However, the death rate for Korean men is similar to the global average (ASR, 3.2 vs. 3.3 per 100,000 people). The incidence of bladder cancer in Korean women is also higher than the global average (ASR, 4.8 vs. 1.2 per 100,000 people). It is also similar to that of North America (ASR, 4.7 per 100,000 people). The death rate of Korean women is also higher than the global average (ASR, 1.4 vs. 0.9 per 100,000 people). Since 2000, the incidence of bladder cancer has been observed to vary by sex in many countries. The incidence in men has tended to stabilize or decrease, while that in women has shown an increasing trend in some European countries [18,19]. However, Korea has shown increasing incidence in both men and women. The increasing incidence of bladder cancer in women is presumed to be partly related to an increase in women's smoking rate [20]. Bladder cancer mortality has decreased in major developed countries due to the diversification of treatment methods and the development of immunotherapeutic agents, but it has tended to increase in Korea.

CONCLUSIONS

Since 2000, the number of patients with urologic cancer in Korea has increased. The incidence of prostate, kidney, and bladder cancer has also continued to rise. In 2004, prostate cancer surpassed kidney cancer and ranked first among urologic cancers. The morbidity and death rate rates also continued to increase, and men had higher prevalence and death rates than women with kidney and bladder cancers. As of 2019, the 5-year relative survival rates of patients diagnosed with prostate cancer, kidney cancer, and bladder cancer significantly improved to 94.4%, 84.7%, and 76.5%, respectively. The survival rates for urologic cancer are increasing; however, the incidence and prevalence rates continue to rise.

Supplementary Materials

Supplementary Tables 1-9 can be found via https://doi.org/10.22465/juo.234600080004.
Supplementary Table 1.
Number of urologic cancer cases by region in Korea in 2020
juo-21-1-32-Supplementary-Table-1.pdf
Supplementary Table 2.
Trends in the incidence of urologic cancer from 2000 to 2020 in Korea
juo-21-1-32-Supplementary-Table-2.pdf
Supplementary Table 3.
Trends in the age-standardized incidence rate of urologic cancer by age from 1999 to 2019 in Korea
juo-21-1-32-Supplementary-Table-3.pdf
Supplementary Table 4.
Trends in the incidence rate of urologic cancer from 2000 to 2020 in Korea, both sexes
juo-21-1-32-Supplementary-Table-4.pdf
Supplementary Table 5.
Trends in the crude death rate of urologic cancer by age from 2000 to 2020 in Korea
juo-21-1-32-Supplementary-Table-5.pdf
Supplementary Table 6.
Trends in the prevalence of urologic cancer from 2007 to 2020 in Korea
juo-21-1-32-Supplementary-Table-6.pdf
Supplementary Table 7.
Trends in the crude prevalence rate of urologic cancer from 2007 to 2019 in Korea in both sexes
juo-21-1-32-Supplementary-Table-7.pdf
Supplementary Table 8.
Trends in the prevalence rate of urologic cancer by age from 2007 to 2019 in Korea
juo-21-1-32-Supplementary-Table-8.pdf
Supplementary Table 9.
Trends in the 5-year relative survival rates (%) of urologic cancer by sex and year of diagnosis from 1993 to 2019 in Korea
juo-21-1-32-Supplementary-Table-9.pdf

NOTES

Conflicts of Interest

The authors have nothing to disclose.

Funding/Support

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author Contribution

Conceptualization: HDY; Data curation: SHH; Formal analysis: HDY; Methodology: HDY; Project administration: HDY; Visualization: SHH, HDY; Writing - original draft: SHH, HDY; Writing - review & editing: HDY.

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