Trends in Incidence of Metastatic Prostate Cancer in the US

Abstract

Importance: The US Preventive Services Task Force (USPSTF) has recommended against routine prostate-specific antigen (PSA)-based prostate cancer (PCa) screening, initially for men older than 75 years in 2008, and then for all men in 2012. Concern has been raised that, by recommending against screening, and thus early detection, the USPSTF recommendations may be associated with an increase in the incidence of metastatic PCa (mPCa).

Objective: To explore the incidence of mPCa before and after the USPSTF recommendations against routine PCa screening.

Design, setting, and participants: This population-based cohort study used the recently released Surveillance, Epidemiology, and End Results (SEER) 18 registry incidence data to identify men aged 45 years and older with a diagnosis of invasive PCa from 2004 through 2018. Data were analyzed from January 1, 2004 to December 31, 2018.

Exposure: Outcomes were assessed before vs after the USPSTF recommendations against routine screening.

Main outcomes and measures: Annual age-adjusted incidence rates per 100 000 population of mPCa (defined using SEER Summary Stage and American Joint Committee on Cancer [AJCC] staging systems), with adjustments for age structure and reporting delay from 2004 to 2011, according to race and age were examined. Annual percentage changes (APCs) were calculated to quantify changes in the annual incidence rates.

Results: From 2004 to 2018, a total of 836 282 patients with PCa were recorded in the SEER database; 26 642 (56.5%) distant mPCa cases were reported in men aged 45 to 74 years, and 20 507 (43.5%) cases were reported in men aged 75 years or older. Among men aged 45 to 74 years, the incidence rate of distant mPCa (SEER Summary staging) remained stable during 2004 to 2010 (APC, -0.4%; 95% CI, -1.7% to 1.1%; P = .60), then increased significantly during 2010 to 2018 (APC, 5.3%; 95% CI, 4.5% to 6.0%; P < .001). In men aged 75 years or older, the incidence rate of distant mPCa decreased from 2004 to 2011 (APC, -1.5%; 95% CI, -3.0% to 0%; P = .046), and then increased from 2011 to 2018 (APC, 6.5%; 95% CI, 5.1% to 7.8%; P < .001). Similar trends were also seen for M1 mPCa defined per the AJCC staging system. These increased trends in mPCa incidence were particularly significant in non-Hispanic White men (2010-2018 APC, 6.9%; 95% CI, 5.4% to 8.4%; P < .001).

Conclusions and relevance: Analysis of the emerging trends from the most recently released SEER data set (2004-2018) suggests that the incidence rates of mPCa have increased significantly and coincide temporally with the USPSTF recommendations against PCa screening across races and age groups. These mPCa trends are associated with reported changes in screening practices following the USPSTF recommendations.

Figure.. Trends in Invasive Prostate Cancer: Surveillance, Epidemiology, and End Results 18 Registries 2004-2018 for All Races

The line segments of each curve were calculated with the Joinpoint Regression Analysis program. For each cohort, we compared the percentage difference in incidence rate (IR) between the lowest and the highest modeled value. Panel A shows data for derived SEER summary stage (distant); in men older than 75 years, the IR of metastatic prostate cancer (mPCa) increased by 43% from 2011 to 2018, from an annual percentage change (APC) of −1.5% to 6.5%, and in men aged 45 to 74, the IR of mPCa increased by 41% from 2010 to 2018, from an APC of −0.4% to 5.3%. Panel B shows data for derived American Joint Committee on Cancer (AJCC) M-stage (M1); in men older than 75 years, the IR of mPCa increased by 43% from 2010 to 2018, from an APC of −2.3% to 5.6%, and in men aged 45 to 74 years, the IR of mPCa increased by 39% from 2010 to 2018, from an APC of −0.1% to 5.1%. Panel C shows data for derived AJCC N-stage (N1); in men older than 75 years, the IR of N1 disease increased by 119% from 2004 to 2018, from an APC of 12.6% to 8.8%, and in men aged 45 to 74 years, the IR of N1 disease increased by 81% from 2004 to 2018, from an APC of 3.4% to 10.4%. Panel D shows data for derived AJCC T-stage (T3-T4); in men older than 75 years, the IR of T3-T4 disease increased by 45% from 2012 to 2018, from an APC of 2.3% to 7.9%, and in men aged 45 to 74 years, the IR of T3-T4 disease increased by 31% from 2013 to 2018, from an APC of −2.2% to 6.5%. Trends categorized by race are reported in eTable 1, eTable 2, and eTable 3 in the Supplement.