Abstract
In the United States, disease-specific mortality from prostate cancer (PC) is highest among black men. While the introduction of widespread PSA testing has been associated with a downward stage migration, whether this trend continues in the late PSA era and for black men is unknown. The objective of our study was to evaluate current PC stage migration patterns in the United States by race. The Surveillance, Epidemiology and End Results (SEER) registry was queried to obtain all cases of PC reported between 2000 and 2013. Year of diagnosis was categorized into 2000-2003, 2004-2007, 2008-2010 and 2011-2013. Predictors of distant stage PC at diagnosis were determined using logistic regression adjusted for year of diagnosis, age at diagnosis, SEER region and race. A total of 791 184 PC cases were identified. The cohort comprised 78.9% (n=594 920) white and 14.1% (n=106 133) black men. The stage at diagnosis was 83.3% localized, 12.0% regional and 4.7% distant. Age-adjusted incidence demonstrated a steady decline for black men in all time groups while white men had a stable incidence of distant disease between 2000 and 2013. In univariate analysis, black men in the 2004-2007 (OR 0.86 (0.81-0.93)) and 2008-2010 cohorts (OR 0.85 (0.79-0.91)) were less likely to be diagnosed with metastatic PC as compared with the 2000-2003 baseline cohort. In multivariate analysis, the 2004-2007 black cohort was less likely to be diagnosed with distant PC (OR 0.90 (0.84-0.97)). This trend was not observed in white men who in multivariate analysis had an increased risk of distant PC in the 2004-2007 (OR 1.08 (1.04-1.11)), 2008-2010 (OR 1.22 (1.18-1.27)) and 2011-2013 (OR 1.65 (1.59-1.71)) groups. PC downward stage migration continues in black men but not in white men. Discontinuation of PSA-based screening for PC could disproportionately affect black men.
Highlights
In the United States, the modern era of prostate cancer (PC)screening and treatment began with the Food and DrugAdministration approval of PSA in 1986 for use as a serum marker for monitoring treatment response and recurrence.[1]
PSA testing was widely adopted by patients and physicians alike and the number of PC diagnoses sharply increased with the introduction of a screening test to a previously unscreened population.[3]
Numerous studies demonstrated a shift towards a lower stage of disease on surgical radical prostatectomy specimens[4,5,6,7] as well as a decrease in the number of patients presenting with metastatic PC.[8,9,10]
Summary
Administration approval of PSA in 1986 for use as a serum marker for monitoring treatment response and recurrence.[1] In 1991, Catalona et al.[2] published the results of a landmark trial for the use of PSA as a screening test for the detection of PC in asymptomatic men over the age of 50, leading to Food and Drug Administration approval for the use of the PSA test as a population screening test During this initial era, PSA testing was widely adopted by patients and physicians alike and the number of PC diagnoses sharply increased with the introduction of a screening test to a previously unscreened population.[3] Since numerous studies demonstrated a shift towards a lower stage of disease on surgical radical prostatectomy specimens[4,5,6,7] as well as a decrease in the number of patients presenting with metastatic PC.[8,9,10] Despite these trends in pathological staging and metastatic disease, randomized controlled screening trials in the United States[11] and Europe[12] have reached differing conclusions regarding the impact of PSA screening on mortality. Prostate Cancer and Prostatic Diseases (2017) 20, 210–215; doi:10.1038/pcan.2016.68; published online 17 January 2017
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