Annual Report to the Nation on the Status of Cancer, part II: Recent changes in prostate cancer trends and disease characteristics

Abstract

Background: Temporal trends in prostate cancer incidence and death rates have been attributed to changing patterns of screening and improved treatment (mortality only), among other factors. This study evaluated contemporary national-level trends and their relations with prostate-specific antigen (PSA) testing prevalence and explored trends in incidence according to disease characteristics with stage-specific, delay-adjusted rates.

Methods: Joinpoint regression was used to examine changes in delay-adjusted prostate cancer incidence rates from population-based US cancer registries from 2000 to 2014 by age categories, race, and disease characteristics, including stage, PSA, Gleason score, and clinical extension. In addition, the analysis included trends for prostate cancer mortality between 1975 and 2015 by race and the estimation of PSA testing prevalence between 1987 and 2005. The annual percent change was calculated for periods defined by significant trend change points.

Results: For all age groups, overall prostate cancer incidence rates declined approximately 6.5% per year from 2007. However, the incidence of distant-stage disease increased from 2010 to 2014. The incidence of disease according to higher PSA levels or Gleason scores at diagnosis did not increase. After years of significant decline (from 1993 to 2013), the overall prostate cancer mortality trend stabilized from 2013 to 2015.

Conclusions: After a decline in PSA test usage, there has been an increased burden of late-stage disease, and the decline in prostate cancer mortality has leveled off. Cancer 2018;124:2801-2814. © 2018 American Cancer Society.

Keywords: Gleason score; incidence; mortality; prostate cancer; prostate-specific antigen; trends.

Figure 1

Trends in the proportion of men aged ≥50 years who received PSA testing in the prior year in the United States in 1987‐2005 (reconstructed from data from Medicare claims and the NHIS and based on methodology in Mariotto et al12) and trends in age‐ and delay‐adjusted prostate cancer incidence rates among men of all races combined by stage at diagnosis in SEER 9 in 1975‐2014. (A) Percentage of men having at least 1 PSA test in the prior year and their first PSA test in the prior year (NHIS): ages ≥ 50 years. (B) Prostate cancer incidence rates (SEER 9): all stages and all races. (C) Prostate cancer incidence rates (SEER 9): distant stage and all races. Rates are per 100,000 persons and have been age‐adjusted to the 2000 US standard population and delay‐adjusted for age and stage at diagnosis. Note that the y‐axis ratio for panel B to panel C is 10:1. The SEER 9 registries are Atlanta, Connecticut, Detroit, Hawaii, Iowa, New Mexico, San Francisco–Oakland, Seattle–Puget Sound, and Utah. ^{^}The trend was statistically significant from 0 (P < .05). APC indicates annual percent change; NHIS, National Health Interview Survey; PSA, prostate‐specific antigen; SEER, Surveillance, Epidemiology, and End Results.

Figure 2

Trends in the proportion of men aged ≥50 years who received a PSA screening test in the prior year by age group in 2000‐2015 (NHIS) and trends in age‐ and delay‐adjusted prostate cancer incidence rates by race, age group, and stage at diagnosis from 42 registries representing 89% of the US population in 2001‐2014 (NAACCR). (A) PSA screening in the prior year: ages ≥ 50 years. (B) PSA screening in the prior year: ages of 50 to 74 years. (C) PSA screening in the prior year: ages ≥ 75 years. (D) Incidence rates and joinpoint trends: all stages and all ages. (E) Incidence rates and joinpoint trends: all stages and ages of 50 to 74 years. (F) Incidence rates and joinpoint trends: all stages and ages ≥ 75 years. (G) Incidence rates and joinpoint trends: distant stage and all ages. (H) Incidence rates and joinpoint trends: distant stage and ages of 50 to 74 years. (I) Incidence rates and joinpoint trends: distant stage and ages ≥ 75 years. Error bars represent 95% confidence intervals. Rates are per 100,000 persons and have been delay‐adjusted for age and stage at diagnosis. Note that panels D to I have different y‐axes. ^{^}The trend was statistically significant from 0 (P < .05). *Better ascertainment of the year in which the test was received. APC indicates annual percent change; NAACCR, North American Association for Central Cancer Registries; NHIS, National Health Interview Survey; PSA, prostate‐specific antigen.

Figure 3

Trends in age‐ and delay‐adjusted prostate cancer incidence rates and proportions of cases by PSA value and age category in SEER 18 in 2004‐2014. (A) Incidence rates by PSA category: all ages. (B) Proportions by PSA category: all ages. (C) Incidence rates by PSA category: ages of 50 to 74 years. (D) Proportions by PSA category: ages of 50 to 74 years. (E) Incidence rates by PSA category: ages ≥ 75 years. (F) Proportions by PSA category: ages ≥ 75 years. Rates are per 100,000 persons and have been delay‐adjusted for age and stage at diagnosis. The SEER 18 registries are Connecticut, Georgia, the Greater California, Hawaii, Iowa, Kentucky, Louisiana, New Jersey, New Mexico, Utah, the Alaska Native Tumor Registry, Arizona Indians, the Cherokee Nation Cancer Registry, metropolitan Atlanta and rural Georgia, San Francisco–Oakland and San Jose–Monterey, Los Angeles, Detroit, and Seattle–Puget Sound. ^{^}The trend was statistically significant from 0 (P < .05). APC indicates annual percent change; PSA, prostate‐specific antigen; SEER, Surveillance, Epidemiology, and End Results.

Figure 4

Trends in age‐ and delay‐adjusted prostate cancer incidence rates and proportions of cases by GS and age category in SEER 18 in 2004‐2014. (A) Incidence rates by GS category: all ages. (B) Proportions by GS category: all ages. (C) Incidence rates by GS category: ages of 50 to 74 years. (D) Proportions by GS category: ages of 50 to 74 years. (E) Incidence rates by GS category: ages ≥ 75 years. (F) Proportions by GS category: ages ≥ 75 years. Rates are per 100,000 persons and have been delay‐adjusted for age and stage at diagnosis. The SEER 18 registries are Connecticut, Georgia, the Greater California, Hawaii, Iowa, Kentucky, Louisiana, New Jersey, New Mexico, Utah, the Alaska Native Tumor Registry, Arizona Indians, the Cherokee Nation Cancer Registry, metropolitan Atlanta and rural Georgia, San Francisco–Oakland and San Jose–Monterey, Los Angeles, Detroit, and Seattle–Puget Sound. ^{^}The trend was statistically significant from 0 (P < .05). APC indicates annual percent change; GS, Gleason score; SEER, Surveillance, Epidemiology, and End Results.

Figure 5

Trends in age‐ and delay‐adjusted prostate cancer incidence rates and proportions of cases by clinical extension and age category in SEER 18 in 2004‐2014. (A) Incidence rates by cT: all ages. (B) Proportions by cT: all ages. (C) Incidence rates by cT: ages of 50 to 74 years. (D) Proportions by cT: ages of 50 to 74 years. (E) Incidence rates by cT: ages ≥ 75 years. (F) Proportions by cT: ages ≥ 75 years. Rates are per 100,000 persons and have been delay‐adjusted for age and stage at diagnosis. The SEER 18 registries are Connecticut, Georgia, the Greater California, Hawaii, Iowa, Kentucky, Louisiana, New Jersey, New Mexico, Utah, the Alaska Native Tumor Registry, Arizona Indians, the Cherokee Nation Cancer Registry, metropolitan Atlanta and rural Georgia, San Francisco–Oakland and San Jose–Monterey, Los Angeles, Detroit, and Seattle–Puget Sound. ^{^}The trend was statistically significant from 0 (P < .05). APC indicates annual percent change; SEER, Surveillance, Epidemiology, and End Results.

Figure 6

Trends in prostate cancer death rates by race in the United States in 1975‐2015 (National Center for Health Statistics). Rates are per 100,000 persons and have been age‐adjusted to the 2000 US standard population. ^{^}The trend was statistically significant from 0 (P < .05). APC indicates annual percent change.