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 >98 ng/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. The US Preventive Services Task Force recommendations against prostate cancer screening might have indirectly led to an increase in the incidence of newly diagnosed metastatic prostate cancer mPCa). Our analysis revealed that the annual rate of newly diagnosed mPCa increased by 25% over the past decade. The median age at initial diagnosis decreased from 71 to 68 yr. We also observed a higher rate of aggressive tumours (Gleason score 8–10) and a lower rate of visceral (M1c) metastatic disease. These results are worrisome and warrant attention in future investigations addressing the phenomenon of adverse stage migration across all PCa stages.