Early-Stage Prostate Cancer Diagnoses Continue to Decline, Mirroring PSA Testing Declines

The incidence of early-stage prostate cancer in men 50 years and older has continued to decline, with lower rates in 2013 compared to 2012. This is a likely result of the October 2011 recommendation from the US Preventive Services Task Force (USPSTF) against routine prostate-specific antigen (PSA) testing in all men.

The 2011 USPSTF recommendation (which was finalized in May 2012) followed a 2008 recommendation against PSA testing only in men aged 75 years or older. The group noted that the reduction in prostate cancer mortality after 10 to 14 years is “at most, very small,” and there is no apparent reduction in all-cause mortality. The likelihood of overdiagnosis and overtreatment led to the recommendation against PSA testing.

The new study, led by Ahmedin Jemal, DVM, PhD, of the American Cancer Society in Atlanta, follows up on earlier work showing that early-stage prostate cancer diagnoses dropped between 2011 and 2012 in men over the age of 50. It used data from 18 registries in the Surveillance, Epidemiology, and End Results (SEER) program; the results were published online ahead of print in JAMA Oncology.

The incidence rate of localized/regional-stage prostate cancer fell from 356.5 per 100,000 men aged 50 to 74 years in 2012 to 335.4 per 100,000 men in 2013. This yielded an incidence ratio (IR) of 0.94 (99% CI, 0.92–0.96).

For those aged 75 years and older, the rates fell from 379.2 per 100,000 men in 2012 to 353.6 per 100,000 men in 2013, yielding an IR of 0.93 (99% CI, 0.89–0.97). The IRs for distant-stage disease remained unchanged between these two years, in both the younger and older groups of men. The authors noted that the results were similar in non-Hispanic whites and non-Hispanic blacks, though the decrease was not statistically significant in black men-this could have been due to a lack of statistical power.

The decrease of approximately 6% was lower than the previous report, when it dropped by 19% from 2011 to 2012. PSA testing rates between 2010 and 2013 have also dropped significantly, from 36.8% to 29.9% in the 50 to 74 years group and from 43.1% to 36.3% in the older group of men.

“Whether this pattern will lead to a future increase in the diagnosis of distant-stage disease and prostate cancer mortality requires long-term monitoring because of the slow-growing nature of this malignant neoplasm,” the authors concluded.