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Clinical research

Contemporary national trends in prostate cancer risk profile at diagnosis

Prostate Cancer and Prostatic Diseases volume 23, pages 81–87 (2020)Cite this article

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Abstract

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.

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Acknowledgements

The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigators.

Funding

ASK is supported by the DiNovi Family Fund. QDT is supported by an unrestricted educational grant from the Vattikuti Urology Institute, a Clay Hamlin Young Investigator Award from the Prostate Cancer Foundation and a Genentech BioOncology Career Development Award from the Conquer Cancer Foundation of the American Society of Clinical Oncology.

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Author notes

  1. These authors contributed equally: Sean A. Fletcher, Nicolas von Landenberg

Authors and Affiliations

  1. Division of Urologic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Sean A. Fletcher, Alexander P. Cole, Quoc-Dien Trinh & Adam S. Kibel

  2. Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Sean A. Fletcher, Nicolas von Landenberg, Alexander P. Cole, Philipp Gild, Stuart R. Lipsitz & Quoc-Dien Trinh

  3. Department of Urology, Ruhr-University Bochum, Marien Hospital Herne, Herne, Germany

    Nicolas von Landenberg

  4. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Philipp Gild

  5. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Toni K. Choueiri

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Correspondence to Adam S. Kibel.

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Conflict of interest

ASK reports consulting fees from, Insightec, Merck, Pfizer, Janssen, and Profound Medical. QDT reports honoraria from Bayer and Astellas US. The remaing authors declare that they have no conflict of interest.

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Fletcher, S.A., von Landenberg, N., Cole, A.P. et al. Contemporary national trends in prostate cancer risk profile at diagnosis. Prostate Cancer Prostatic Dis 23, 81–87 (2020). https://doi.org/10.1038/s41391-019-0157-y

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