Early-Stage Prostate Cancer Incidence Rates Decline, Distant-Stage Disease Rates Unchanged in 2013
Jemal et al described findings indicating a continued decline in the incidence of localized/regional-stage prostate cancer at 2 years after the U.S. Preventive Services Task Force recommendation against routine prostate-specific antigen (PSA) screening in men aged ≥ 50 years in 2011, in a letter to the editor in JAMA Oncology. However, no change in the incidence of distant-stage disease was observed between 2012 and 2013.
The investigators previously identified a marked decline in the incidence of early-stage prostate cancer from 2011 to 2012 in men aged ≥ 50 years using SEER (Surveillance, Epidemiology, and End Results) data. The recommendation against routine PSA testing in men aged ≥ 75 years was released in 2008.
Incidence of Early- and Distant-Stage Disease
The study involved data from men aged ≥ 50 years with prostate cancer diagnosed from 2005 through 2013 in 18 SEER registries, covering approximately 28% of the U.S. population.
From 2012 to 2013, the incidence rates of localized/regional-stage cancer per 100,000 men decreased from 356.5 to 335.4 (incidence ratio [IR] = 0.94, 99% confidence interval [CI] = 0.92–0.96) in those aged 50 to 74 years and from 379.2 to 353.6 (IR = 0.93, 99% CI = 0.89–0.97) in those aged ≥ 75 years. For 2012 vs 2013, the incidence rates for distant-stage disease were 15.7 vs 16.5 (IR = 1.05, 99% CI = 0.96–1.15) in those aged 50 to 74 years and 65.8 vs 66.4 (IR = 1.01, 99% CI = 0.91–1.12) in those aged ≥ 75 years.
Results were similar among white patients and black patients. The reduction in the incidence of early-stage disease did not achieve significance among black patients, potentially due to inadequate statistical power.
Smaller Reduction
The decrease in the incidence of early-stage disease in men aged ≥ 50 years between 2012 and 2013 was smaller than that between 2011 and 2012 (6% vs 19%). PSA-testing rates decreased from 36.8% to 29.9% between 2010 and 2013 in men aged 50 to 74 years and from 43.1% to 36.3% in those aged ≥ 75 years.
The investigators concluded: “[T]he decrease in early-stage prostate cancer incidence rates from 2011 to 2012 in men 50 years and older persisted through 2013 in SEER registries, albeit at a slower pace. Whether this pattern will lead to a future increase in the diagnosis of distant-stage disease and prostate cancer mortality requires long-term monitoring because of the slow growing nature of this malignant neoplasm.”
The study was supported by the Intramural Research Department of the American Cancer Society.
Ahmedin Jemal, DVM, PhD, of the American Cancer Society, is the corresponding author of the JAMA Oncology article.
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