ONCOmmunity

Grade Migration of Prostate Cancer in the United States during the last decade.

By: Leonardo D Borregales, Gina DeMeo, Xiangmei Gu, Emily Cheng, Vanessa Dudley, Edward M Schaeffer, Himanshu Nagar, Sigrid Carlsson, Andrew Vickers, Jim C Hu

Department of Urology, Weill Cornell Medicine/ New York-Presbyterian, New York, New York, USA.
2022-01-26; doi: 10.1093/jnci/djac066

Abstract

Background

Prostate cancer (PC) screening guidelines have changed over the last decade to reduce overdiagnosis and overtreatment of low-grade disease. We sought to examine and attempt to explain how changes in screening strategies have impacted temporal trends in Gleason Grade Group (GG) PC at diagnosis and radical prostatectomy (RP) pathology.

Methods

Using SEER Registry Database, we identified 438,432 men with newly diagnosed PC during 2010-2018. Temporal trends in incidence of GG at biopsy, radical prostatectomy pathology, PSA level, and metastasis at diagnosis were examined. The NHIS database was examined to evaluate trends in PSA-screening rates and a literature review evaluating MRI and biomarkers utilization during this period was performed.

Results

Between 2010-2018, the incidence of low-grade PC (GG1) decreased from 52 to 26 cases per 100,000(p < 0.001). The incidence of GG1 as a proportion of all PC decreased from 47% to 32%, and the proportion of GG1 at RP pathology decreased from 32% to 10%(p < 0.001). However, metastases at diagnosis increased from 3.0% to 5.2%(p < 0.001). During 2010-2013, PSA screening rates in men 50-74 years declined from 39 to 32 per 100 men and remained stable. Utilization rates of MRI and biomarkers modestly increased from 7.2% in 2012 to 17% in 2019, and 1.3% in 2012 to 13% in 2019, respectively.

Conclusions

We found a significant decrease in the diagnosis and treatment of GG1 PC between 2010-2018. Changes in PSA screening practices appear as the primary contributor. Public health efforts should be directed towards addressing the increase in the diagnoses of metastatic PC.