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 100000 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 836282 patients with PCa were recorded in the SEER database; 26642 (56.5%) distant mPCa cases were reported in men aged 45 to 74 years, and 20507 (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