USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles.
Los Angeles Cancer Surveillance Program, Keck School of Medicine, University of Southern California, Los Angeles.
JAMA Netw Open. 2022 Mar 1;5(3):e222246. doi: 10.1001/jamanetworkopen.2022.2246.
The US Preventive Services Task Force (USPSTF) has recommended against routine prostate-specific antigen (PSA)-based prostate cancer (PCa) screening, initially for men older than 75 years in 2008, and then for all men in 2012. Concern has been raised that, by recommending against screening, and thus early detection, the USPSTF recommendations may be associated with an increase in the incidence of metastatic PCa (mPCa).
To explore the incidence of mPCa before and after the USPSTF recommendations against routine PCa screening.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used the recently released Surveillance, Epidemiology, and End Results (SEER) 18 registry incidence data to identify men aged 45 years and older with a diagnosis of invasive PCa from 2004 through 2018. Data were analyzed from January 1, 2004 to December 31, 2018.
Outcomes were assessed before vs after the USPSTF recommendations against routine screening.
Annual age-adjusted incidence rates per 100 000 population of mPCa (defined using SEER Summary Stage and American Joint Committee on Cancer [AJCC] staging systems), with adjustments for age structure and reporting delay from 2004 to 2011, according to race and age were examined. Annual percentage changes (APCs) were calculated to quantify changes in the annual incidence rates.
From 2004 to 2018, a total of 836 282 patients with PCa were recorded in the SEER database; 26 642 (56.5%) distant mPCa cases were reported in men aged 45 to 74 years, and 20 507 (43.5%) cases were reported in men aged 75 years or older. Among men aged 45 to 74 years, the incidence rate of distant mPCa (SEER Summary staging) remained stable during 2004 to 2010 (APC, -0.4%; 95% CI, -1.7% to 1.1%; P = .60), then increased significantly during 2010 to 2018 (APC, 5.3%; 95% CI, 4.5% to 6.0%; P < .001). In men aged 75 years or older, the incidence rate of distant mPCa decreased from 2004 to 2011 (APC, -1.5%; 95% CI, -3.0% to 0%; P = .046), and then increased from 2011 to 2018 (APC, 6.5%; 95% CI, 5.1% to 7.8%; P < .001). Similar trends were also seen for M1 mPCa defined per the AJCC staging system. These increased trends in mPCa incidence were particularly significant in non-Hispanic White men (2010-2018 APC, 6.9%; 95% CI, 5.4% to 8.4%; P < .001).
Analysis of the emerging trends from the most recently released SEER data set (2004-2018) suggests that the incidence rates of mPCa have increased significantly and coincide temporally with the USPSTF recommendations against PCa screening across races and age groups. These mPCa trends are associated with reported changes in screening practices following the USPSTF recommendations.
美国预防服务工作组 (USPSTF) 最初于 2008 年建议 75 岁以上的男性不进行常规前列腺特异性抗原 (PSA) 前列腺癌 (PCa) 筛查，然后于 2012 年建议所有男性不进行常规筛查。有人担心，USPSTF 的建议不建议进行筛查，从而无法早期发现，可能会导致转移性 PCa (mPCa) 的发病率增加。
探讨 USPSTF 反对常规 PCa 筛查建议前后 mPCa 的发病率。
设计、设置和参与者：本基于人群的队列研究使用最近发布的监测、流行病学和最终结果 (SEER) 18 登记发病率数据，从 2004 年至 2018 年，确定年龄在 45 岁及以上、诊断为侵袭性 PCa 的男性。数据从 2004 年 1 月 1 日分析至 2018 年 12 月 31 日。
根据 USPSTF 反对常规筛查的建议，评估结局。
使用 SEER 汇总分期和美国癌症联合委员会 (AJCC) 分期系统，根据种族和年龄，从 2004 年至 2011 年，调整年龄结构和报告延迟，评估 mPCa (定义为使用 SEER 汇总分期和 AJCC 分期系统) 的每 100000 人年发病率。计算年度百分比变化 (APC)，以量化年度发病率的变化。
从 2004 年至 2018 年，SEER 数据库中记录了 836282 例 PCa 患者；45 岁至 74 岁男性中报告了 26642 例远处 mPCa 病例 (56.5%)，75 岁或以上男性中报告了 20507 例病例 (43.5%)。在 45 岁至 74 岁的男性中，远处 mPCa (SEER 汇总分期) 的发病率在 2004 年至 2010 年期间保持稳定 (APC，-0.4%；95%CI，-1.7%至 1.1%；P = .60)，然后在 2010 年至 2018 年期间显著增加 (APC，5.3%；95%CI，4.5%至 6.0%；P < .001)。在 75 岁或以上的男性中，远处 mPCa 的发病率从 2004 年至 2011 年下降 (APC，-1.5%；95%CI，-3.0%至 0%；P = .046)，然后从 2011 年至 2018 年增加 (APC，6.5%；95%CI，5.1%至 7.8%；P < .001)。使用 AJCC 分期系统定义的 M1 mPCa 也出现了类似的趋势。这些 mPCa 发病率的上升趋势在非西班牙裔白人男性中尤为显著 (2010-2018 APC，6.9%；95%CI，5.4%至 8.4%；P < .001)。
对最近发布的 SEER 数据集 (2004-2018) 的分析结果表明，mPCa 的发病率显著增加，与 USPSTF 反对跨种族和年龄组进行 PCa 筛查的建议时间一致。这些 mPCa 趋势与 USPSTF 建议后报告的筛查实践变化有关。
