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 (US) 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 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 2005-2016 in men aged ≥50 years stratified by stage (local, regional, and distant), age group (50-74 and ≥75), and race/ethnicity (all races/ethnicities, non-Hispanic whites, and non-Hispanic blacks) with joinpoint regression models to estimate annual percent changes. Tests of statistical significance are two-sided, P < 0.05. Results For all races/ethnicities combined, incidence for local-stage disease declined beginning in 2007 in men aged 50-74 and ≥75 years though the decline stabilized during 2013-2016 in men aged ≥75 years. Incidence decreased by 6.4% (95%CI, 4-9%-7.9%) per year from 2007-2016 in men aged 50-74 years and by 10.7% (95%CI, 6.2%-15.0%) per year from 2007-2013 in men aged ≥75 years. 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 increased by 5.2% (95%CI, 4.2%-6.1%) per year from 2010-2016. Conclusions Regional- and distant-stage prostate cancer incidence continue to increase in the US in men aged ≥50 years, and future studies are needed to identify reasons for the rising trends.

Cancer Statistics, 2021

“…However, this decision was largely based on clinical trial data that have been criticized for widespread screening among control subjects and insufficient follow‐up time 37 . Since around 2010, there has been an increase in distant‐stage prostate cancer diagnoses across age and race, 38‐40 and, in 2017 the US Preventive Services Task Force upgraded their recommendation for men aged 55 to 69 years to informed decision making (grade C) 41‐43 . There is some evidence that the long‐term benefit of screening is underappreciated, particularly given recent advances in mitigating over detection through more stringent diagnostic criteria and reducing overtreatment via active surveillance for low‐risk disease 37,44,45 …”

“…During the late 1990s and 2000s, the prostate cancer death rate declined by 4% per year on average because of advances in treatment and earlier stage diagnosis through PSA testing 75,76 . However, PSA testing dropped by about 10 percentage points in absolute terms from 2008 to 2013, 77,78 which coincided with an uptick in distant‐stage diagnoses 38,40 followed by a stable mortality trend from 2013 to 2018.…”

Prostate Cancer Incidence and Survival, by Stage and Race/Ethnicity — United States, 2001–2017

“…recommended against PSA-based screening for prostate cancer for men of all ages. This recommendation likely contributed to a decrease in overall reported prostate cancer incidence and might have contributed to an increase in the percentage and incidence of distant stage prostate cancer (2,3). Despite decreasing incidence of localized stage prostate cancer, 130,658 to 190,570 new cases were diagnosed each year in the United States during 2003-2017.…”

Prostate-Specific Antigen Screening and Recent Increases in Advanced Prostate Cancer

“…According to the National Health Interview Survey, between 2008 and 2015 there was a nearly 10% decrease in the proportion of men aged 50 years and older who said they had been screened in the prior 12 months ( 6 ). Jemal and colleagues recently estimated an annual 5% increase in incident metastatic prostate cancer from 2010 to 2016 among men aged 50 years and older ( 7 ). Contemporary data from the Surveillance, Epidemiology, and End Results (SEER) program demonstrate that newly diagnosed metastatic prostate cancer cases increased by 39% in the 5 years after the 2012 USPSTF recommendation ( 8 ).…”