Increase in the Annual Rate of Newly Diagnosed Metastatic Prostate Cancer: A Contemporary Analysis of the Surveillance, Epidemiology and End Results Database.

Background: Reported recommendations against prostate specific antigen (PSA) screening may have negatively affected the rates of newly diagnosed metastatic prostate cancer (mPCa).

Objectives: To investigate the annual rate of newly diagnosed mPCa and changes in disease characteristic at presentation over time in a large North American patient cohort.

Design, Setting, And Participants: Within the Surveillance, Epidemiology and End Results database (2004-2014) we identified 12 939 patients newly diagnosed with mPCa.

Outcome Measurements And Statistical Analysis: We used LOWESS to plot the annual trends for age, PSA (<50, 50-98, and >98ng/ml), clinical T stage (T1, T2, and T3-4), biopsy Gleason score ([GS] ≤6, 7, and 8-10), and M1a, M1b, and M1c substages. Multivariable logistic regression was used to test the effect of more contemporary year of diagnosis (YOD; 2014) on PSA, cT stage, GS, and M substage distributions. Multivariable linear regression was used to test the effect of more contemporary YOD on patient age.

Results And Limitations: Between 2004 and 2014, the age-adjusted incidence of newly diagnosed mPCa increased from 1.9 to 2.4 cases per 100 000 population (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.18-1.44; p<0.0001). Rates of cT1 (from 23% to 37%; OR 1.85; p<0.0001), GS 8-10 (from 67% to 85%; OR 2.62; p<0.0001), and M1a disease (from 4.5% to 6.0%; OR 2.16; p=0.006) increased. Conversely, patient age at initial mPCa diagnosis decreased from 71 to 68 yr (coefficient -0.14; p<0.001). The PSA level at diagnosis remained stable over time. A limitation is the lack of detail on the distribution of metastatic disease.

Conclusions: The rate of newly diagnosed mPCa increased by 25% over the past decade and the age at initial presentation decreased. These observations may be indicative of diagnostic delays related to less frequent PSA screening.

Patient Summary: The US Preventive Services Task Force recommendations against prostate cancer screening might have indirectly caused an increase in the rate of newly diagnosed metastatic prostate cancer.