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.
Highlights
Prostate cancer is the most commonly diagnosed malignancy in American men with incidence trends being sensitive to screening [1]
The United States Preventive Services Task Force (USPSTF) issued a grade D recommendation regarding prostate specific antigen (PSA) screening in men of all ages, considering the limited benefit of and potential risks associated with prostate biopsy and cancer overtreatment [5]
The first was in December 2007, from −19.4% annual percent change (APC) to −2.5% APC and the second in May 2011, when the incidence rate began another steep decline, −19.6% APC (Table 2)
Summary
Prostate cancer is the most commonly diagnosed malignancy in American men with incidence trends being sensitive to screening [1]. Following the introduction of prostate specific antigen (PSA) screening for prostate cancer in the 1980’s, the incidence rate increased to a peak of 237 per 100,000 per year among U.S males in 1992 and has gradually declined since that time. The USPSTF issued a grade D recommendation regarding PSA screening in men of all ages, considering the limited benefit of and potential risks associated with prostate biopsy and cancer overtreatment [5]. This USPSTF recommendation was presented in a draft document in October 2011 and final recommendation released May 2012. Previous studies have predicted decline of localized prostate cancers [6] and the long-term risk of an increase
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