Contemporary national trends in prostate cancer risk profile at diagnosis

TY - JOUR

T1 - Contemporary national trends in prostate cancer risk profile at diagnosis

AU - Fletcher, Sean A

AU - von Landenberg, Nicolas

AU - Cole, Alexander P

AU - Gild, Philipp

AU - Choueiri, Toni K

AU - Lipsitz, Stuart R

AU - Trinh, Quoc-Dien

AU - Kibel, Adam S

PY - 2020/3

Y1 - 2020/3

N2 - BACKGROUND: Over the past decade prostate cancer (PCa) diagnostic approaches have evolved away from aggressive prostate-specific antigen (PSA) screening. While a goal of these changes is to decrease over diagnosis and treatment, little is known about the downstream effects on PCa risk distribution at the time of diagnosis. To better understand these effects, we used a national cohort of men to investigate temporal trends in PCa risk profile at diagnosis.METHODS: Using the National Cancer Database, we identified men diagnosed with biopsy-confirmed clinically localized prostate adenocarcinoma (T1-4N0M0) from 2004 to 2014. We assessed temporal trends in proportional distribution of National Comprehensive Cancer Network risk groups as well as their sub-components (PSA, Gleason score, clinical T stage). We also evaluated trends in these sub-components among men with intermediate- and high-risk disease as well as those with metastatic disease.RESULTS: In our cohort of 755,567 men diagnosed between 2004 and 2014, there was a decrease in the proportion of men diagnosed with low-risk PCa (38.32 to 27.23%, p < 0.001) and a consequent increase in the proportion of localized intermediate-risk (40.49 to 46.72%, p < 0.001) and high-risk diagnoses (21.19 to 26.05%, p < 0.001). This was primarily driven by an increased proportion of Gleason 7 and Gleason 8-10 cancer, respectively. The number of men presenting with metastatic disease consistently increased from 3251 (2.88%) in 2004 to 6886 (7.19%) in 2014 (p < 0.001).CONCLUSIONS: The proportion of localized intermediate/high risk and metastatic PCa has substantially increased over the past decade, while the proportion of low-risk disease has decreased. This shift has been primarily driven by increased diagnosis of high-grade disease. National guidelines advising against PSA screening may have contributed to these findings.

AB - BACKGROUND: Over the past decade prostate cancer (PCa) diagnostic approaches have evolved away from aggressive prostate-specific antigen (PSA) screening. While a goal of these changes is to decrease over diagnosis and treatment, little is known about the downstream effects on PCa risk distribution at the time of diagnosis. To better understand these effects, we used a national cohort of men to investigate temporal trends in PCa risk profile at diagnosis.METHODS: Using the National Cancer Database, we identified men diagnosed with biopsy-confirmed clinically localized prostate adenocarcinoma (T1-4N0M0) from 2004 to 2014. We assessed temporal trends in proportional distribution of National Comprehensive Cancer Network risk groups as well as their sub-components (PSA, Gleason score, clinical T stage). We also evaluated trends in these sub-components among men with intermediate- and high-risk disease as well as those with metastatic disease.RESULTS: In our cohort of 755,567 men diagnosed between 2004 and 2014, there was a decrease in the proportion of men diagnosed with low-risk PCa (38.32 to 27.23%, p < 0.001) and a consequent increase in the proportion of localized intermediate-risk (40.49 to 46.72%, p < 0.001) and high-risk diagnoses (21.19 to 26.05%, p < 0.001). This was primarily driven by an increased proportion of Gleason 7 and Gleason 8-10 cancer, respectively. The number of men presenting with metastatic disease consistently increased from 3251 (2.88%) in 2004 to 6886 (7.19%) in 2014 (p < 0.001).CONCLUSIONS: The proportion of localized intermediate/high risk and metastatic PCa has substantially increased over the past decade, while the proportion of low-risk disease has decreased. This shift has been primarily driven by increased diagnosis of high-grade disease. National guidelines advising against PSA screening may have contributed to these findings.

KW - Aged

KW - Biomarkers, Tumor

KW - Biopsy

KW - Humans

KW - Male

KW - Mass Screening

KW - Middle Aged

KW - Neoplasm Grading

KW - Neoplasm Metastasis

KW - Neoplasm Staging

KW - Prostatic Neoplasms/diagnosis

KW - Public Health Surveillance

KW - Risk Assessment

U2 - 10.1038/s41391-019-0157-y

DO - 10.1038/s41391-019-0157-y

M3 - SCORING: Journal article

C2 - 31235801

VL - 23

SP - 81

EP - 87

JO - PROSTATE CANCER P D

JF - PROSTATE CANCER P D

SN - 1365-7852

IS - 1

ER -