Prostate cancer screening and incidence among men younger than age 50.

Abstract

183 Background: Prostate cancer has long been considered as a disease of older men. However, age at diagnosis with prostate cancer has continued to decline. Since the introduction of prostate-specific antigen (PSA) test in 1986, the prostate cancer incidence rate has steadily and dramatically increased in men under age 50. This study aims to better understand demographic variations in prostate cancer screening and incidence, and clinical characteristics of prostate cancers in men under age 50. Methods: We examined prostate cancer testing data from the Behavioral Risk Factor Surveillance System (2002, 2004, 2006, and 2008) and prostate cancer incidence data from the CDC's National Program of Cancer Registries and the NCI's Surveillance, Epidemiology, and End Results programs (2001-2006). We estimated the weighted percentage of self-reported cancer testing using SUDAAN and age-adjusted cancer incidence rates and trends using SEER-STAT. Statistical significance for trends was determined by the annual percentage change (APC) differing form zero. Results: A total of 29,176 prostate cancer cases were identified from 2001-2006 among men under age 50. Of these, 551 (1.9%) were among men under age 40. Incidence rates remained stable from 2001-2006; however the incidence of well-differentiated tumors decreased significantly (APC=−24.7) during this time period. About 44% of men aged 40-49 years old reported having a prostate cancer test in the past two years. Prostate cancer testing and incidence rates were highest among men who were black, non-Hispanic, or lived in the northeast. Black men had more than a 2-fold increase in cancer incidence than white men. Conclusions: The magnitude of prostate cancer testing and incidence in men under age 50 reveals significant health/public health problems in this younger population. This study demonstrates substantial regional differences in prostate cancer testing and incidence in men under age 50. It also confirms that prostate cancer testing and incidence varies by race and ethnicity. We observed a large disparity in prostate cancer incidence between blacks and whites. The incidence rate remained stable over time; the dramatic decrease occurred in well-differentiated cancers. No significant financial relationships to disclose.