Annual Report to the Nation on the Status of Cancer, part II: Recent changes in prostate cancer trends and disease characteristics

BACKGROUND: Temporal trends in prostate cancer incidence and death rates have been attributed to changing patterns of screening and improved treatment (mortality only), among other factors. This study evaluated contemporary national‐level trends and their relations with prostate‐specific antigen (PSA) testing prevalence and explored trends in incidence according to disease characteristics with stage‐specific, delay‐adjusted rates. METHODS: Joinpoint regression was used to examine changes in delay‐adjusted prostate cancer incidence rates from population‐based US cancer registries from 2000 to 2014 by age categories, race, and disease characteristics, including stage, PSA, Gleason score, and clinical extension. In addition, the analysis included trends for prostate cancer mortality between 1975 and 2015 by race and the estimation of PSA testing prevalence between 1987 and 2005. The annual percent change was calculated for periods defined by significant trend change points. RESULTS: For all age groups, overall prostate cancer incidence rates declined approximately 6.5% per year from 2007. However, the incidence of distant‐stage disease increased from 2010 to 2014. The incidence of disease according to higher PSA levels or Gleason scores at diagnosis did not increase. After years of significant decline (from 1993 to 2013), the overall prostate cancer mortality trend stabilized from 2013 to 2015. CONCLUSIONS: After a decline in PSA test usage, there has been an increased burden of late‐stage disease, and the decline in prostate cancer mortality has leveled off. Cancer 2018;124:2801‐2814. © 2018 American Cancer Society