Contemporary National Trends in Localized Prostate Cancer Risk Profile at Diagnosis
Fletcher S, Cole A, Von Landenberg N, Berg S, Gild P, Noldus J, Menon M, Trinh QD, and Kibel A. Contemporary National Trends in Localized Prostate Cancer Risk Profile at Diagnosis. Eur Urol, Supplements 2018; 17(2):e1515-e1517.
Eur Urol Suppl
Introduction & Objectives: In the years following the introduction of PSA screening in the early 1990s, there was a documented “stage migration” toward lower risk prostate cancer (PCa) at initial diagnosis that persisted through the 2000s. National policy guidelines such as the US Preventative Services Task Force's (USPSTF) recommendation against PSA screening for men over 75 in 2008, and for all men in 2012, has led to a decline in both screening for and incidence of PCa. The extent to which these policy changes may have impacted contemporary trends in PCa risk stratification at diagnosis is not well known. Materials & Methods: We used the National Cancer Database to identify men diagnosed with localized PCa (cT1-4N0M0) from 2010 through 2014. The Cancer of the Prostate Risk Assessment (CAPRA) score was used to define PCa risk stratification into low, intermediate, and high-risk categories. This risk score incorporates age and PSA at diagnosis, Gleason score of biopsy, clinical T-stage, and percent of biopsy cores positive for cancer; we excluded individuals missing any of this information. We measured the estimated annual percent change (EAPC) in PCa risk profile for each risk category. Results: A total of 265,150 patients were included in the final cohort. From 2010 to 2014 the proportion of patients presenting with low-risk PCa decreased from 43.7% to 33.9%; EAPC: -6.29 (95% CI: -3.95, -8.57), p=0.004. Conversely, the proportion of high-risk PCa diagnoses increased from 16.5% to 22.0%; EAPC: 8.02 (5.09, 11.03), p=0.003. The proportion of intermediate-risk PCa diagnoses also increased, from 39.8% to 44.1%; EAPC: 2.49 (1.99, 3.90), p=0.002. Conclusions: From 2010 to 2014, the proportion of men presenting with low-risk PCa decreased significantly, and there was a concomitant increase in the proportion of men presenting with intermediate and high-risk PCa. Nationwide changes in PSA screening practices may be contributing to these findings.