Recent decline in prostate cancer incidence in the United States, by age, stage, and Gleason score

Abstract

Prostate cancer incidence is sensitive to screening practices, however the impact of recent screening recommendations from the United States Preventative Services Task Force on prostate cancer incidence by age, stage, race, and Gleason score is unknown. This study described the timing and magnitude of changes in prostate cancer incidence trends in the United States by month of diagnosis, and evaluated trends by age, Gleason score, and stage at diagnosis. We analyzed prostate cancer incidence trends using Surveillance, Epidemiology, and End Results (SEER) program data for men diagnosed with invasive prostate cancer from 2007 through 2012. JoinPoint analysis was used to detect changes in the rate of annual percent change (APC) in prostate cancer incidence for all diagnoses and by age, Gleason score, race, and stage. Prostate cancer incidence declined at an estimated -19.6% APC beginning May 2011. This decline was observed in all age groups. Low-grade tumors (Gleason score ≤6) showed a steeper decline (-29.1% APC) than high-grade tumors (Gleason score 8-10: -10.8% APC). Only stage I/II and stage III tumors saw declines (-24.2% and -16.7% APC, respectively). A sharp decline in prostate cancer incidence began before release of the United States Preventative Services Task Force October 2011 draft and May 2012 final screening recommendation. The greatest change occurred with incidence of low-grade tumors, although there is concern that some high-grade tumors may now go undetected.

Keywords: Early detection of cancer; SEER program; incidence; prostate specific antigen; prostatic neoplasms; trends.

Figure 1

Recent trends in prostate cancer incidence in Surveillance, Epidemiology, and End Results 18, JoinPoint regression by month of diagnosis. (A) Prostate cancer incidence, age‐adjusted. (B) Incidence by age at diagnosis. (C) Incidence of low‐ (Gleason score ≤6), intermediate‐ (Gleason score 7) and high‐grade (Gleason score 8–10) prostate tumors, age‐adjusted. (D) Incidence by stage at diagnosis age‐adjusted. (E) Incidence by race and ethnicity, age‐adjusted. Inflection points represent time points of significant change in trend.