Main Session
Sep
29
PQA 06 - Genitourinary Cancer, Gynecological Cancer, and Health Care Access and Engagement
Presenter(s)
Jilcha Feyisa, MD, MPH - Dartmouth-Hitchcock Medical Center, Lebanon, NH
J. D. Feyisa1,2, S. Guha2, A. Krishnan3, N. S. Kapadia1,2, and J. B. Yu1,2; 1Department of Radiation Oncology & Applied Sciences, Dartmouth Cancer Center, Lebanon, NH, 2Geisel School of Medicine at Dartmouth, Hannover, NH, 3Geisel School of Medicine at Dartmouth, Hanover, NH
Purpose/Objective(s):
There have been changes to prostate cancer presentation in terms of aggressiveness and extent of disease at presentation. However, it has been difficult to understand how prostate cancer presentation is changing because of the dramatic changes in the United States Preventive Services Task Force (USPSTF) PSA screening guidelines from 2008 to 2018. We evaluated the change in prostate cancer presentation and temporal relationships with PSA screening guidelines.Materials/Methods:
We analyzed the 2025 release of the National Cancer Data Base (NCDB) and included 2,259,526 prostate adenocarcinoma cases from 2004 to 2022. We also identified 8,463 patients with numeric Decipher GC score from the SEER-Decipher linked database covering 2013-2018. Age-adjusted temporal trends were modeled for four key measures of aggressive disease: 1) PSA > 10 ng/dL, 2) high grade prostate cancer (Gleason score = 8 or any primary or secondary Gleason score of 5), 3) metastatic cancer at diagnosis, and 4) Decipher GC score. Trends were modeled on a log scale for annual percentage change (APC), and joinpoint regression was performed for the four key measures using standard cancer surveillance methodology. For each outcome, up to 2 statistically supported trend changes (“joinpoints”) were allowed.Results:
After adjusting for age, patients who presented with a PSA over 10 ng/dL declined from 2004 until 2009 (APC -2.0% [95% CI -3.2, -0.7]) and then rose substantially from 2009-2018 (APC +4.5% [95% CI +3.8, +5.2%]). These changes closely aligned with PSA screening guideline changes, with breakpoints near 2009 and 2018. The percentage of patients who were presented with high grade cancer was relatively stable from 2004-2008 (APC +1.7% [95% CI -0.2, +3.6]) and 2015-2022 (APC +0.2% [95% CI -0.6, +0.9]). However, during the period of 2008-2015, there was a marked increase (+8.2% [95% CI +7.5, +8.9]). The later 2015 breakpoint where high grade disease began to stabilize did not correspond to a guideline change. Patients presenting with metastatic prostate cancer had a major increase in the age-adjusted rate starting around 2007 (+13.0% [95% CI +11.3, +14.8]). This increase tempered to a more modest increasing pace around 2014 (+2.8% [95% CI +1.6, +4.0]). The breakpoint of 2014 did not clearly align with a guideline change. Finally, though age adjusted mean Decipher score declined modestly from 2010 to 2013 (APC -1.9% per year [95% CI -2.6, -1.3]), it increased rapidly from 2013 to 2016 (APC +4.5% [95% CI +4.2, +4.9]) and then continued to rise but at a slower pace from 2016 to 2018 (APC +2.5% [95% CI +2.4, +2.7]). The joinpoints did not correspond to guideline changes.Conclusion:
There has been a major increase in aggressive prostate cancer, and these increases persist after age adjustment and are not fully accounted for by changes in PSA screening guidelines.