Trends in PSA and metastatic prostate cancer at presentation in the United States from 2004-2022.

Abstract

76 Background: The introduction of prostate-specific antigen (PSA) screening in the mid-1980s led to an increase in the diagnoses of localized prostate cancer relative to metastatic disease. In 2008, the United States Preventive Services Task Force (USPSTF) discouraged screening for men aged 75 and older and in 2012 extended this to all men. In 2018, the USPSTF partially reversed their position to recommend individualized screening for men aged 55 to 69. We investigated the association between the implementation of these guidelines on the average PSA and metastatic stage of disease at initial diagnosis. Methods: We analyzed the 2025 release of the National Cancer Data Base (NCDB) and included patients diagnosed with prostate adenocarcinoma from 2004 to 2022. Data for PSA, metastatic disease, and year of diagnosis were recorded. We report trends by era (2004-2007, 2008-2011, 2012-2017, and 2018-2022). Results: A total of 2,259,526 men with a diagnosis of prostate cancer were identified in the NCDB. The mean age at diagnosis declined form 65.5 years during first era to 64.6 years in the second era and then increased to 66.4 years in the third era. The median PSA level at diagnosis declined from 6.1 ng/mL in 2004 to 5.8 ng/mL 2008, but this trend reversed after 2008 with median PSA rising steadily to 7.3 ng/mL by 2018. The incidence of metastatic disease at diagnosis steadily increased from 2,764 (2.7%) in 2004 to 13,043 (9.2%) in 2022. Conclusions: We detected a strong temporal association between PSA screening guidelines and both PSA level and metastatic stage at time of diagnosis. While PSA decreased and then increased, the proportion of patients diagnosed with metastatic disease at presentation rose steadily. The introduction of more sensitive imaging modalities, such as PSMA PET CT may have resulted more detection of metastatic disease at diagnosis, independent of the PSA at diagnosis. An underlying increase in the aggressive disease amongst US men over the past two decades cannot be excluded. Mean age, median PSA, and percentage of men presenting with metastatic disease at diagnosis in USA, 2004-2022. Era Mean age at diagnosis Median PSA at diagnosis Percentage of men presenting with metastatic disease 2004 – 2007 65.6 6.1 2.63% 2008 – 2011 64.7 5.9 3.33% 2012 – 2017 65.5 6.8 6.43% 2018 - 2022 67.0 7.5 8.40%