AUA 2017: Rising Incidence of Metastatic Prostate Cancer in California, 1988-2014

Boston, MA ( Early detection of prostate cancer with PSA based screening can reduce the risk of prostate cancer mortality by 21%. Screening for prostate cancer has dramatically declined in the United States since the United States Preventive Services Task Force (USPSTF) recommended against routine PSA based prostate cancer screening for all men in 2012. This led to dramatic reductions in the diagnosis of localized disease across all clinical risk groups. However, recent analysis of SEER data suggest that metastatic incidence rates are rising primarily for older men (Hu J et al. JAMA Oncology, 2017).

Dr. Dall’Era presented his study, where he tried to analyze trends in newly diagnosed metastatic prostate cancer incidence, and specifically the impact of patient age and race on these trends. Using a large population based database (California Cancer registry), new prostate cancer incidence was analyzed by stage at diagnosis between 1988-2014. Additional stratification was performed by age and the four major race/ethnicity groups (non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic and non-Hispanic Asian/PI (API)).

The results showed that adjusted rates of remote prostate cancer incidence for men of all races aged 65-74 and NHW men of all ages significantly increased over the most recent time period by 2.4% and 1%, respectively, (P<0.05). In contrast, incidence of remote prostate cancer continued to decline for NHB (-2.42%), Hispanic (-1.94%), and API (-1.66%) men. Furthermore, localized disease incidence continued to decline significantly for all age and racial groups.

In conclusion, Incidence rates of newly metastatic prostate cancer have significantly increased for the first time in California for white and for men aged 65-74 of all races. This is in contrast to declines in previous decades and ongoing rate declines for other racial groups studied. In contrast, localized disease rates continue to significantly decline corresponding to reductions in PSA screening in the last decade.

Although it is not possible to determine the exact etiology of these findings, there is a very high probability that decreased PSA screening and reduction in early detection of aggressive tumors is more than likely to contribute to these results.

Presented By: Marc Dall’Era, Sacramento, CA

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA