Author(s): Daniel Guerrero Gutierrez, Jade Viveiros
Mentor(s): Ray Merrill
Institution BYU
Prostate-specific antigen (PSA) screening recommendations in the United States have undergone significant changes in recent years, influencing trends in prostate cancer (PCa) incidence. This study examines PCa incidence rates and trends between 2007 to 2021, focusing on the impact of age, race/ethnicity, and tumor stage. Data were derived from 777,152 PCa cases diagnosed across 17 population-based tumor registries in the Surveillance, Epidemiology, and End Results Program (SEER) of the US National Cancer Institute. Age-adjusted incidence rates per 100,000 were calculated, with trends analyzed using annual percentage change (APC) and join point regression. The results revealed a decline in PCa incidence rates from 165.8 per 100,000 in 2007 to 101.0 in 2014 (APC: -6.51; p < 0.05), followed by an increase to 121.2 per 100,000 in 2021 (APC: 1.87; p < 0.05). This pattern was observed among men aged 55–69 and ≥70 years across all racial/ethnic groups, except for Hispanic men, who did not exhibit the post-2014 increase. The observed trends were most pronounced in cases diagnosed at local or regional stages. Cases identified through autopsy or death certificates constituted 0.68% to 1.37% across racial/ethnic groups, while the proportion of unstaged cases varied significantly by race/ethnicity, ranging from 4.13% in non-Hispanic White men to 9.5% in Hispanic men (p < 0.0001, Chi-square test). Treatment modalities varied markedly by age, tumor stage, and racial/ethnic group. From 2017 to 2021, surgery was performed in 33% of cases, predominantly in local/regional stage cancer cases and inversely correlated with age. Radiation was utilized in 30% of cases. While chemotherapy was rare (2% overall), with higher usage (9%-38%) among older patients with distant-stage cancer. Racial/ethnic disparities in treatment were evident; for example, non-Hispanic Black men with local/regional disease were less likely to receive surgery, but more likely to receive radiation compared to non-Hispanic White men. These findings underscore the need for tailored PSA screening and PCa treatment strategies that consider demographic factors. By examining incidence trends by tumor stage, age, and race/ethnicity, this study provides insights to guide public health initiatives and policy decisions aimed at optimizing PSA screening protocols and improving treatment outcomes across diverse populations.