Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, NY, USA.
Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA.
J Natl Cancer Inst. 2022 Jul 11;114(7):1012-1019. doi: 10.1093/jnci/djac066.
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 pathology.
Using the Surveillance, Epidemiology, and End Results 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, prostate-specific antigen (PSA) level, and metastasis at diagnosis were examined. The National Health Interview Survey database was examined to evaluate trends in PSA-screening rates, and a literature review evaluating magnetic resonance imaging and biomarkers utilization during this period was performed.
Between 2010 and 2018, the incidence of low-grade PC (GG1) decreased from 52 to 26 cases per 100 000 (P < .001). The incidence of GG1 as a proportion of all PC decreased from 47% to 32%, and the proportion of GG1 at radical prostatectomy pathology decreased from 32% to 10% (P < .001). However, metastases at diagnosis increased from 3.0% to 5.2% (P < .001). During 2010-2013, PSA screening rates in men aged 50-74 years declined from 39 to 32 per 100 men and remained stable. Utilization rates of magnetic resonance imaging and biomarkers modestly increased from 7.2% in 2012 to 17% in 2019 and 1.3% in 2012 to 13% in 2019, respectively.
We found a significant decrease in the diagnosis and treatment of GG1 PC between 2010 and 2018. Changes in PSA screening practices appear as the primary contributor. Public health efforts should be directed toward addressing the increase in the diagnoses of metastatic PC.
在过去的十年中，前列腺癌（PC）筛查指南发生了变化，以减少低级别疾病的过度诊断和过度治疗。我们试图研究和解释筛查策略的变化如何影响诊断时 Gleason 分级组（GG）PC 和根治性前列腺切除术病理的时间趋势。
我们使用监测、流行病学和最终结果登记处数据库，确定了 2010 年至 2018 年间新诊断为 PC 的 438432 名男性。检查了活检、根治性前列腺切除术病理、前列腺特异性抗原（PSA）水平和诊断时转移的 GG 发生率的时间趋势。检查了国家健康访谈调查数据库以评估 PSA 筛查率的趋势，并对该期间磁共振成像和生物标志物应用的文献进行了综述。
2010 年至 2018 年间，低级别 PC（GG1）的发病率从每 100000 人 52 例降至 26 例（P<.001）。GG1 在所有 PC 中的比例从 47%降至 32%，GG1 在根治性前列腺切除术病理中的比例从 32%降至 10%（P<.001）。然而，诊断时转移的比例从 3.0%增加到 5.2%（P<.001）。2010 年至 2013 年间，50-74 岁男性的 PSA 筛查率从每 100 人 39 例降至 32 例，并保持稳定。磁共振成像和生物标志物的使用率分别从 2012 年的 7.2%和 1.3%略微增加到 2019 年的 17%和 13%。
我们发现 2010 年至 2018 年间 GG1 PC 的诊断和治疗显著减少。PSA 筛查实践的变化似乎是主要原因。公共卫生工作应致力于解决转移性 PC 诊断的增加。
