BACKGROUND: Prostate cancer incidence has been increasing in most developed countries in the absence of similar trends in mortality, and with variable patterns in different areas of the world. MATERIALS AND METHODS: Trends in incidence and mortality from prostate cancer for the period 1974-1994 were analysed using data from the Cancer Registries of the Swiss Cantons of Vaud and Neuchâtel. Of 5,010 cases registered, 80% were histologically or cytologically confirmed. RESULTS: Age-standardized incidence rates increased from 33.1 to 48.6 per 100,000 (+47%). The upward trends were greater in the most recent calendar periods, and in the younger age groups (+77% at age 45 to 54; +57% at age 55 to 64). In contrast, mortality was stable, with an overall increase of only 3% in age-standardized rates (from 20.4 to 21.0 per 100,000), due to some increase in men aged 65 or above. Consequently, the incidence/mortality rate ratios increased from 1.6 in 1974-1979 to 2.3 in 1990-1994. Five-year observed and relative survivals increased from 26% to 41% and from 46% to 58%, respectively. Ten-year observed and relative survival for cases diagnosed in 1985-1989 were 19% and 42%, respectively. Survival improvements were greater below age 75. CONCLUSION: The pattern of trends in incidence, mortality and survival confirms the influence of improved diagnosis of prostate cancer over the last few years in this European population. Still, while Swiss prostatic cancer mortality rates are the highest in the world (20.3 per 100,000, world standard), i.e., about 30% higher than in the United States, all races combined, incidence rates are still half as much. On account of the steady increase of prostate-specific antigen testing in Switzerland, further incidence increases are likely.