Changing Incidence of Metastatic Prostate Cancer by Race and Age, 1988-2015

Eur Urol Focus. 2019 Nov;5(6):1014-1021. doi: 10.1016/j.euf.2018.04.016. Epub 2018 May 4.


Background: Screening for prostate cancer (PCa) has dramatically declined in the United States (US) since the United States Preventive Services Task Force recommended against routine prostate-specific antigen (PSA)-based PCa screening in all men in 2012. This led to dramatic reductions in the diagnosis of localized disease across all clinical risk groups.

Objective: In light of decreased PSA screening for men in the US, we sought to study trends in newly diagnosed metastatic PCa incidence and how this may vary by race and age.

Design, setting, and participants: We analyzed new PCa incidence by stage at diagnosis between 1988 and 2015 within the Cancer Registry of Greater California. We further stratified the patients by age and four major race/ethnicity groups (Hispanic, non-Hispanic white [NHW], non-Hispanic black [NHB], and non-Hispanic Asian/Pacific Islander [API]). Incidence rates were calculated and compared per 100000 and age-adjusted to the 2000 US standard population.

Outcome measurement and statistical analysis: The primary outcome was incidence of metastatic PCa at the time of cancer diagnosis. Joinpoint regression program was used to detect changes in incidence and to calculate the average percent change (APC) over time. All data were analyzed using SEER*Stat version 8.1.15 and Joinpoint Regression Program version 4.1.0, and a two-sided p value of <0.05 was considered statistically significant.

Results and limitations: Adjusted rates of metastatic PCa incidence for NHW men significantly increased by 4.3% since 2010, while remaining down (NHB, Hispanic) or level (API) for other racial groups. Stratified by age, incidence of metastatic disease for all races has increased significantly for men aged 64-75 yr since 2008 with an APC of 2.8% while remaining level for other age groups. The limitations of our study include retrospective design and no data on extent of PSA screening in the study cohort.

Conclusions: Incidence rates of newly diagnosed metastatic PCa have significantly increased for NHW men and men aged 65-74 yr.

Patient summary: Prostate-specific antigen screening has declined in the Unites States with a subsequent sharp drop in the incidence of screen-detected localized prostate cancer. The incidence of men presenting with metastatic disease seems to be rising recently, and men should continue to discuss the benefits of PSA screening with their primary care doctor.

Keywords: Age; Incidence; Metastatic disease; Prostate cancer; Race.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Advisory Committees
  • African Americans / statistics & numerical data
  • Age Factors
  • Aged
  • Case-Control Studies
  • Ethnicity / statistics & numerical data
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Incidence
  • Male
  • Mass Screening / legislation & jurisprudence*
  • Middle Aged
  • Neoplasm Metastasis / pathology
  • Neoplasm Staging / methods
  • Prostate-Specific Antigen / standards
  • Prostatic Neoplasms / epidemiology*
  • Prostatic Neoplasms / ethnology*
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / secondary*
  • Registries
  • Retrospective Studies
  • United States / epidemiology


  • Prostate-Specific Antigen