Contemporary Trends in the Incidence of Metastatic Prostate Cancer Among US Men: Results from Nationwide Analyses

Abstract

Studies have noted contrasting findings with regard to the contemporary incidence of metastatic prostate cancer (PCa) in the USA, especially in light of the United States Preventive Services Task Force (USPSTF) recommendations against prostate-specific antigen (PSA) screening in recent years. We used data from the 18 population- based tumor registries of the Surveillance, Epidemiology and End Results (SEER) 2004-2013 database to study trends in the incidence of metastatic PCa among men stratified by age and race. Joinpoint regression analyses were performed to identify time points associated with any statistically significant change in incidence. Overall, there was a significant increase in incidence between 2009 and 2013 (annual percentage change [APC] 3.10%; p<0.05). In age-stratified analyses, there was a continuous increase in the incidence of metastatic PCa from 2004 to 2013 among men aged 45-54 yr and 55-64 yr (APC 1.77% and 1.43% respectively; both p<0.05). For men aged ≥75 yr there was a significant decline in the incidence of metastatic PCa from 2004 to 2011 (APC -2.07%; p<0.05) and a nonsignificant increase from 2011 onwards (APC 6.09%). Distinct incidence trends were noted for white and black men. While it is too early to presume that the recent decline in PSA screening secondary to the USPSTF statement is causally associated with our findings, our results highlight a concerning trend of increasing metastatic disease. Our results thus warrant validation in future longer-term studies on the contemporary incidence and mortality of metastatic PCa. PATIENT SUMMARY: We noted increasing incidence of metastatic prostate cancer from 2009 onwards among US men (especially those aged 45-74 yr) in a population-based tumor registry. Pending validation in longer-term studies, our results suggest the need for close surveillance of trends for metastatic prostate cancer incidence and mortality.

Keywords: Epidemiology and End Results database; Metastatic prostate cancer; Prostate-specific antigen screening; Surveillance; US Preventive Services Task Force.