Prostate Cancer Incidence 5 Years After US Preventive Services Task Force Recommendations Against Screening

Abstract

Background: Previous studies reported that prostate cancer incidence rates in the United States declined for local-stage disease and increased for regional- and distant-stage disease following the US Preventive Services Task Force recommendations against prostate-specific antigen-based screening for men aged 75 years and older in 2008 and for all men in 2012. It is unknown, however, whether these patterns persisted through 2016.

Methods: Based on the US Cancer Statistics Public Use Research Database, we examined temporal trends in invasive prostate cancer incidence from 2005 to 2016 in men aged 50 years and older stratified by stage (local, regional, and distant), age group (50-74 years and 75 years and older), and race and ethnicity (all races and ethnicities, non-Hispanic Whites, and non-Hispanic Blacks) with joinpoint regression models to estimate annual percent changes. Tests of statistical significance are 2-sided (P < .05).

Results: For all races and ethnicities combined, incidence for local-stage disease declined beginning in 2007 in men aged 50-74 years and 75 years and older, although the decline stabilized during 2013-2016 in men aged 75 years and older. Incidence decreased by 6.4% (95% CI = 4.9%-9% to 7.9%) per year from 2007 to 2016 in men aged 50-74 years and by 10.7% (95% CI = 6.2% to 15.0%) per year from 2007 to 2013 in men aged 75 years and older. In contrast, incidence for regional- and distant-stage disease increased in both age groups during the study period. For example, distant-stage incidence in men aged 75 years and older increased by 5.2% (95% CI = 4.2% to 6.1%) per year from 2010 to 2016.

Conclusions: Regional- and distant-stage prostate cancer incidence continue to increase in the United States in men aged 50 years and older, and future studies are needed to identify reasons for the rising trends.

Figure 1.

Trends in annual age-standardized prostate cancer incidence rates in men aged 50 years and older in the United States by stage, 2005-2016. Solid lines represent joinpoint modeled rates, and symbols represent observed rates. Source: U.S. Cancer Statistics Public Use Research Database, November 2018 submission (2001-2016) (6).

Figure 2.

Trends in annual age-standardized prostate cancer incidence rates by stage at diagnosis, race and ethnicity, and age in the United States, 2005-2016. A) Trends for all races combined by stage at diagnosis for men aged 50-74 years and 75 years and older. Solid lines represent joinpoint modeled rates, and symbols represent observed rates. B) Trends for non-Hispanic Whites (NHW) by stage at diagnosis for men aged 50-74 and 75 years and older. Solid lines represent joinpoint modeled rates, and symbols represent observed rates. C) Trends for non-Hispanic Blacks (NHB) by stage at diagnosis for men aged 50-74 and 75 years and older. Solid lines represent joinpoint modeled rates, and symbols represent observed rates. Source: U.S. Cancer Statistics Public Use Research Database, November 2018 submission (2001-2016) (6).

Figure 3.

Annual total number of excess distant-stage cases in men aged 50 years and older in the United States since 2009. Calculated as the differences between observed cases and expected cases if the rate for distant-stage disease had remained at their lowest level (2008 rate). Source: U.S. Cancer Statistics Public Use Research Database, November 2018 submission (2001-2016) (6).

Figure 4.

Annual total number of local-stage cases avoided in men aged 50 years and older in the United States since 2008. Calculated as the differences between observed cases and expected cases if the rate for early stage disease had remained at their peak rate (2007 rate). Source: U.S. Cancer Statistics Public Use Research Database, November 2018 submission (2001-2016) (6).

Figure 5.

Non-Hispanic Black to non-Hispanic White incidence rate ratio for distant-stage prostate cancer by age, 2005-2016. Source: U.S. Cancer Statistics Public Use Research Database, November 2018 submission (2001-2016) (6).