Time trends in the epidemiology of newly diagnosed stage IV prostate cancer in the United States: An analysis of data from the Surveillance, Epidemiology, and End Results (SEER) Program (1988 - 2003)

Abstract

5059 Background: Despite the addition of prostate specific antigen (PSA) screening in the 1990s, a significant proportion of patients still present with late-stage prostate cancer. To better understand this group of patients, we examined recent time trends in the epidemiology of prostate cancer initially diagnosed at stage IV. Methods: Data from SEER were used to calculate annual incidence rates of stage IV prostate cancer from 1988 to 2003 and to describe the patient characteristics and survival for three time periods (1988–1992, 1993–1997, and 1998–2003). Regression analysis (joinpoint) was used to identify significant changes in trends over time with respect to stage IV prostate cancer incidence and patient characteristics. Results: The age-adjusted incidence rate of stage IV prostate cancer was 28 per 100,000 men in 1988 and steadily declined to 12 per 100,000 men in 2003 (an average decrease of 6.4% per year, p<0.05). The proportion of men diagnosed at age 18–65 years significantly increased across the study period (23% during 1988–1992 to 39% during 1998- 2003). Additionally, more unmarried men were diagnosed with stage IV tumors over time. Overall, 5-year survival for stage IV cancer increased across the study period. Of those diagnosed at age ≤ 50 years during 1998–2003, 65% survived at least five years compared to a five- year survival of 37% for those diagnosed during 1988–1992. A similar pattern was seen for those aged 51 to 70 years. In contrast, 5-year survival among those aged 71 to 80 years remained relatively constant over time (approximately 48%) and actually decreased in those aged ≥ 80 years (40% during 1988–1992 to 24% during 1998–2003). Conclusions: The age-adjusted incidence of stage IV prostate cancer declined over the past two decades. The proportion of men diagnosed at younger ages (65 years or less) continues to increase, and 5- year survival among this group appears to be improving. As younger men may expect to live longer with stage IV disease, we must consider long term management of their disease. Increased public awareness of these trends as well as the development of clinical trials for men presenting with advanced disease are needed. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Amgen Inc. Amgen Inc. Amgen Inc. Amgen Inc. Amgen Inc.