Page 55 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

Trends in Prostate Cancer Incidence

Prostate cancer incidence trends in the United States during the last 30 years have been
largely driven by changes in screening practices, mainly the implementation of prostate specific
antigen (PSA) screening. Empirical analyses of incidence data and simulation studies
demonstrate that patterns in prostate cancer incidence are compatible with the introduction and
widespread use of a sensitive screening test, resulting in increases in the number of new cases
diagnosed every year. The NCI’s Cancer Trends Progress Report (2009/10) indicates that
prostate cancer incidence rates rose between 1975 and 1992 (from approximately 100 to more
than 240 new cases per 100,000 men per year), and then fell until around 1995. After a period of
nonsignificant increase from 1995 to 2000, rates declined again from 2000 to 2007 (to the
current level of approximately 156 new cases per 100,000 men per year; Figure 4).

Figure 4. Age-adjusted SEER incidence rates for prostate cancer (1975–2008)

Only includes invasive cancer cases. Incidence data pertain to SEER9 areas: San Francisco, Connecticut, Detroit, Hawaii, Iowa,
New Mexico, Seattle, Utah and Atlanta. Rates are presented per 100,000 and are age-adjusted to the 2000 U.S. standard
population. Regression lines were fitted through joinpoint regression. Image obtained from SEER Fast Stats
(http://seer.cancer.gov/faststats/index.php; last accessed September 30, 2011).

Overall, 33 studies provided information on trends in prostate cancer incidence (Appendix
Table C1.2). Of these, 11 provided information stratified by patient age, 17,27,28,35,38,39,43,55,57,59,79
17 by race/ethnicity, 16,17,19,21,25,32,34,42,43,45,46,49,57,76,80,83,84 15 by tumor
stage, 17,18,20,23,26,27,34,35,42,50,52,55,56,76,85 and 5 by tumor grade. 17,21,42,52,56 No studies that met our
inclusion criteria provided information stratified by the other factors relevant to Key Question 1
(comorbidity, tumor volume, PSA, biopsy frequency, number of cores obtained at biopsy, or
system level characteristics).
Studies providing information on cancer incidence were large (median sample size = 51,337;
th
th
25 -75 percentile 39,566-100,212), were published between 1990 and 2011, and provided
information for years 1969 to 2007.

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