Contemporary changes in localized and metastatic prostate cancer incidence by geographic area following decreased PSA screening.

1567 Background: In the setting of decreased PSA screening, the incidence of metastatic prostate cancer has been increasing in the United States. This was chronologically proceeded by decreasing localized prostate cancer incidence. While decreased detection of localized disease is hypothesized to increase likelihood of metastatic disease at diagnosis, it is unclear whether the two are geographically connected. Methods: Prostate cancer incidence was obtained from the of Surveillance, Epidemiology, and End Results (SEER) database for men 70 years or older. SEER Summary Stage 2000 was used to classify localized (local) and metastatic (distant) prostate cancers. Changes in incidence rates were calculated by health services areas (HSA), which each represents a relatively self-contained region of hospital care. We chose a priori to examine most recent years 2012-2015 for changes in metastatic disease, and proceeding years 2008-2011 for changes in localized disease. Population-weighted linear regression that was robust to outliers was performed. Results: A total of over 66,600 cases of localized and 6,400 cases of metastatic prostate cancer from 200 HSAs were included for analysis. From 2008 to 2011, localized incidence decreased from 613.6 to 534.2 per 100,000 men overall, and for each HSA on average decreased by 30.3 per 100,000 men for each year. From 2012 to 2015, metastatic incidence increased from 54.7 to 62.1 per 100,000 men overall, and for each HSA on average increased by 2.1 per 100,000 men for each year. Linear regression between HSA-level changes in localized and metastatic disease revealed a correlation coefficient of -0.023 (SE = 0.017, p = 0.16, 95% CI -0.056 to 0.009), representing lack of a statistically significant relationship between decreases in localized disease and later increases in metastatic disease within each health services region. Conclusions: Despite concerns of increasing metastatic prostate cancer incidence coinciding with decreases in PSA screening and localized cancer incidence, we do not observe a statistically significant geographic and temporal relationship between metastatic and localized disease at the HSA level. Our study is limited by short lead time and thus this trend warrants continued surveillance.

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Geographic-Level Association of Contemporary Changes in Localized and Metastatic Prostate Cancer Incidence in the Era of Decreasing PSA Screening

Cancer Control ◽

10.1177/1073274820902267 ◽

2020 ◽

Vol 27 (1) ◽

pp. 107327482090226

Author(s):

Daniel X. Yang ◽

Danil V. Makarov ◽

Cary P. Gross ◽

James B. Yu

Keyword(s):

Prostate Cancer ◽

Metastatic Disease ◽

Cancer Incidence ◽

Metastatic Prostate Cancer ◽

Care Service ◽

Health Care Service ◽

Specific Antigen ◽

Prostate Cancer Incidence ◽

Recent Increase ◽

Service Areas

Decreased prostate-specific antigen screening since 2008 has generated much concern, including report of recent increase in metastatic prostate cancer incidence among older men. Although increased metastatic disease was temporally proceeded by decreased screening and decreased localized prostate cancer at diagnosis, it is unclear whether the 2 trends are geographically connected. We therefore used the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database to assess geographic-specific associations between changes in localized (2008-2011) and later changes in metastatic prostate cancer incidence (2012-2015). We examined trends from 200 health-care service areas (HSAs) within SEER 18 registries. While on average for each HSA, localized incidence decreased by 27.4 and metastatic incidence increased by 2.3 per 100 000 men per year, individual HSA-level changes in localized incidence did not correlate with later changes in metastatic disease. Decreased detection of localized disease may not fully explain the recent increase in metastatic disease at diagnosis.

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Racial and age specific differences in localized and metastatic prostate cancer incidence: 1988-2013.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.211 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 211-211

Author(s):

Marc Dall'Era ◽

Ralph deVere White ◽

Danielle Rodgriguez ◽

Rosemary Donaldson Cress

Keyword(s):

Prostate Cancer ◽

Cancer Incidence ◽

Metastatic Prostate Cancer ◽

Prostate Cancer Screening ◽

The United States ◽

Incidence Rates ◽

Localized Prostate Cancer ◽

Prostate Cancer Incidence ◽

Race Ethnicity ◽

The Impact

211 Background: The United States Preventive Services Task Force (USPSTF) recommended against routine PSA based prostate cancer screening in all men in 2012. This led to dramatic reductions in screening and rates of localized disease across all clinical risk groups. We sought to study the impact of this on rates of metastatic disease, specifically by patient race and age. Methods: We analyzed new prostate cancer incidence by stage at diagnosis between 1988-2013 within the Cancer Registry of Greater California. We further stratified cases by four major race/ethnicity groups (non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic and non-Hispanic Asian/PI (API)) and age. Incidence rates were calculated and compared per 100,000 and age-adjusted to the 2000 US Standard Population. Joinpoint regression was used to detect changes in incidence and to calculate the average percent change (APC). Results: Adjusted rates of remote prostate cancer incidence for NHW men increased slightly in the most recent decade (+0.28%) after steady declines in previous years with the inflection point occurring in 2002, however this was not statistically significant. In contrast, incidence of remote prostate cancer continued to decline for NHB (-2.73%), Hispanic (-2.04%), and API (-1.45%) men. The greatest increase of +1.1% a year since 2002 was observed for NHW men under age 65. The incidence of localized prostate cancer declined for all race/ethnicity groups over the most recent time period and also declined in all age groups. After remaining relatively flat since 1992, incidence of localized prostate cancer among NHW men declined by over 8% per year starting in 2007 compared with a more gradual decline of -3.52% a year since 2000 for NHB, and more recent declines of -14.41% and -16.64% for Hispanic and API men, respectively. Incidence of regional stage cancer also declined in all groups, but less dramatically. Conclusions: Incidence rates of newly metastatic prostate cancer have not significantly changed since PSA screening declined in the US although we noted a slight upward trend primarily for younger, white men since 2002.

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Association of reductions in PSA screening across states with increased metastatic prostate cancer in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.228 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 228-228

Author(s):

Vidit Sharma ◽

Abhishek Venkataramana ◽

W. Scott Comulada ◽

Mark S. Litwin ◽

Christopher Saigal

Keyword(s):

Prostate Cancer ◽

United States ◽

Linear Regression ◽

Regression Model ◽

Random Effects ◽

Linear Regression Model ◽

Metastatic Prostate Cancer ◽

The United States ◽

Psa Screening ◽

The Mean

228 Background: While PSA screening was found to reduce prostate cancer metastasis and mortality in a large European randomized trial, PSA screening has also resulted in over-treatment of prostate cancer with significant quality-of-life implications. As a result, the US Preventive Services Task Force (USPSTF) did not recommend PSA screening in 2008 and 2012. It is unknown if reductions in PSA screening were responsible for increased metastatic prostate cancer in the United States. We test this hypothesis by associating longitudinal variations across individual states in PSA screening with their incidence of metastatic prostate cancer at diagnosis from 2002 to 2016. Methods: Age-adjusted incidences of metastatic prostate cancer at diagnosis per 100,000 men were obtained from the North American Association of Central Cancer Registries in 2002 – 2016 for each state. Survey-weighted PSA screening estimates for each state were extracted from the Behavioral Risk Factor Surveillance System, which collects this information for men at least 40 years of age every 2 years from 2002 onward. PSA screening and metastasis data were collated as a multi-panel time series and then analyzed using a random-effects linear regression model with random effects at the state level. Results: There was significant variation between states in the percent of men age >40 years who reported ever receiving PSA screening (range 40.1% to 70.3%) and in the age-adjusted incidence of metastatic prostate cancer at diagnosis (range 3.3 to 14.3 per 100,000). From 2008 to 2016, the mean percentage of men screened decreased (61.8% to 50.5%) whereas the mean incidence of metastatic prostate cancer at diagnosis increased (6.4 to 9.0 per 100,000; Bonferroni adjusted p < 0.001 for both). A random-effects linear regression model demonstrated that longitudinal reductions across states in PSA screening were associated with increased metastatic prostate cancer (regression coefficient per 100,000 men: 14.9, 95% CI 12.3 – 17.5, p < 0.001). This indicated that states with larger declines in PSA screening had larger increases in the incidence of metastatic prostate cancer at diagnosis. Variation in PSA screening explained 27% of the longitudinal variation in metastatic prostate cancer within states. Conclusions: In the context of randomized trial data demonstrating a metastasis reduction with PSA screening, our study strengthens the epidemiologic evidence that reductions in PSA screening may explain some of the recent increase in metastatic prostate cancer at diagnosis in the United States. The trend of rising metastatic disease at diagnosis is a worrisome consequence that needs attention. Thus, we support shared-decision making policies, such as the 2018 USPSTF update, that may optimize PSA screening utilization to reduce the incidence of metastatic prostate cancer in the United States.

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Re: Dudith Pierre-Victor, Howard L. Parnes, Gerald L. Andriole, et al. Prostate Cancer Incidence and Mortality Following a Negative Biopsy in a Population Undergoing PSA Screening. Urology 2021 Jun 26;S0090-4295(21)00539-2.

Urology ◽

10.1016/j.urology.2021.07.020 ◽

2021 ◽

Author(s):

Patrick Lewicki ◽

Camilo Arenas-Gallo ◽

Spyridon P. Basourakos ◽

Bashir Al Hussein Al Awamlh ◽

Siv Venkat ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Incidence ◽

Prostate Cancer Incidence ◽

Negative Biopsy ◽

Psa Screening ◽

Incidence And Mortality

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PSA Screening and Prostate Cancer Incidence

JAMA ◽

10.1001/jama.1996.03530390021015 ◽

1996 ◽

Vol 275 (15) ◽

pp. 1155 ◽

Cited By ~ 1

Author(s):

Jules J. Berman

Keyword(s):

Prostate Cancer ◽

Cancer Incidence ◽

Prostate Cancer Incidence ◽

Psa Screening

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Age specific trends in prostate cancer tests, incidence and mortality in Australia since the introduction of the Prostate Specific Antigen (PSA) test

10.21203/rs.3.rs-15620/v1 ◽

2020 ◽

Author(s):

Thanya Pathirana ◽

Rehan Sequeira ◽

Chris Del Mar ◽

James A Dickinson ◽

Katy J L Bell ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Incidence ◽

Specific Antigen ◽

Age Groups ◽

Prostate Cancer Incidence ◽

Psa Screening ◽

Prostate Biopsies ◽

Psa Testing ◽

Incidence And Mortality ◽

Incidental Cancer

Abstract BackgroundPopulation trends in PSA screening and prostate cancer incidence do not perfectly correspond. We aimed to better understand relationships between trends in PSA screening, prostate cancer incidence and mortality in Australia.MethodsDescription of age standardised time trends in PSA tests, prostate biopsies, cancer incidence and mortality within Australia for the age groups: 45-74, 75-84, and 85+ years.ResultsPSA testing increased from its introduction in 1989 to a peak in 2008. It then declined in men aged 45-84 years. Prostate biopsies and cancer incidence declined from 1995 to 2000, in parallel with decrease in trans-urethral resections of prostate (TURP). After 2000, changes in biopsies and cancer incidence paralleled PSA screening in men 45-84 years, while in men ≥85 years, biopsies stabilised and incidence declined. More recently a reduction in TURP correlated with increased Dutasteride and Tamsulosin usage. Prostate cancer mortality in men aged 45-74 years remained low throughout. Mortality in men 75-84 years gradually increased until the mid 1990s, then gradually decreased. Mortality in men ≥85 years increased until the mid 1990s, then stabilised.ConclusionsAge specific prostate cancer incidence largely mirrors PSA screening rates. Most deviation may be explained by changes in management of benign prostatic disease and incidental cancer detection. The timing of the small mortality reduction in men 75-84 years is more consistent with benefits from advances in treatment than with early detection through PSA. The large increases in prostate cancer incidence with minimal changes in mortality suggest overdiagnosis.

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