Trends in the Incidence of Fatal Prostate Cancer in the United States by Race

Abstract

Background: Prostate-specific antigen (PSA) testing has dramatically changed the composition of prostate cancer (PCa), making it difficult to interpret incidence trends. New methods are needed to examine temporal trends in the incidence of clinically significant PCa and whether trends vary by race.

Objective: To conduct an in-depth analysis of incidence trends in clinically significant PCa, defined as cases in which PCa was the underlying cause of death within 10 yr of diagnosis.

Design, setting, and participants: We extracted incident PCa cases during the period 1975-2002 and associated causes of death and survival through 2012 from nine cancer registries in the population-based Surveillance Epidemiology and End Results program database.

Outcome measurements and statistical analysis: We applied joinpoint regression analysis to identify when significant changes in trends occurred and age-period-cohort models to examine longitudinal and cross-sectional trends in the incidence of fatal PCa.

Results and limitations: Among 51 680 fatal PCa cases, incidence increased 1% per year prior to 1992, declined 15% per year from 1992 to 1995, and further declined by 5% per year through 2002. Age-specific incidence rates of fatal disease decreased >2% per year among men aged ≥60 yr, yet rates remained relatively stable among men aged ≤55 yr. Fatal disease rates were >2-fold higher in black men compared with white men, a racial disparity that increased to 4.2-fold among younger men.

Conclusions: The incidence of fatal PCa substantially declined after widespread PSA screening and treatment advances. Nevertheless, rates of fatal disease among younger men have remained relatively stable, suggesting the need for additional attention to early onset PCa, especially among black men. The persistent black-to-white racial disparity observed in fatal PCa underscores the need for greater understanding of the causes of this difference so that strategies can be implemented to eliminate racial disparities.

Patient summary: We assessed how the incidence of ultimately fatal prostate cancer (PCa) changed over time. We found that the incidence of fatal PCa declined by >50% since the introduction of prostate-specific antigen testing and advances in treatment options; however, incidence rates among younger men remained relatively stable, and younger black men exhibited a 4.2-fold higher risk for fatal disease compared with white men.

Keywords: Cancer trends; Cause-specific mortality; Disease progression; Prostate cancer; Prostate-specific antigen.

Figure 1

Temporal trends in age-standardized and age-specific incidence rates of fatal prostate cancer, ages 45–84 years, 1975–2002, United States (SEER-9). A) Age-standardized incidence rates of fatal prostate cancer among all men; B) Age-specific incidence rates of fatal prostate cancer by year of diagnosis (5-year age groups). Age-standardized rates are plotted on the log scale and are age-adjusted to the 2000 US standard population. All age-specific incidence rates are plotted on the log scale.

Figure 2

Temporal trends in age-standardized incidence rates of fatal prostate cancer among black and white men by year of diagnosis and corresponding black-to-white rate ratios, ages 45–84 years, 1975–2002, United States (SEER-9). A) Fitted temporal trends in the incidence of fatal prostate cancer with scatter points for black (yellow squares) and white (blue circles) men; B) Black-to-white period-specific rate ratios in the incidence of fatal prostate cancer, adjusted for non-linear cohort effects and conditioned upon age at diagnosis (64 years). The age-standardized incidence rates among black and white men are plotted on the log scale.

Figure 3

Cross-sectional age-specific incidence rates of fatal prostate cancer among black and white men and corresponding black-to-white rate ratios (5-year age group weighted averages), ages 45–84 years, 1975–2002, United States (SEER-9). A) Cross-sectional age-specific incidence rates of fatal prostate cancer among black (yellow squares) and white (blue circles) men, adjusted for non-linear cohort effects and conditioned upon the 1988 central calendar year of diagnosis; B) Black-to-white age-specific (5-year age group weighted averages) rate ratios in the incidence of fatal prostate cancer. The cross-sectional age-specific incidence rates are plotted on the log scale.

Figure 4

Annual hazard rates of death due to prostate cancer as the underlying cause of death (percentage of prostate cancer cases dying each year following diagnosis) stratified by race and calendar period, ages 45–84 years, 1975–2002, United States (SEER-9). Hazard rates are plotted for all prostate cancer cases among white and black men. The period 1975–1988 is classified as the pre-PSA era and the period 1989–2002 as the PSA era.