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Race-based Trends in Metastatic Prostate Cancer at Diagnosis from 2005 to 2020: The Racial Gap is Narrowing
Hanna Zurl, MD1, Zhiyu Qian, MD
2, Klara K. Pohl, MD
1, Andrea Piccolini, MD
3, Stephan M. Korn, MD
3, Muhieddine Labban, ScD
2, Mansoo Cho, MS
3, Sean A. Fletcher, MD
4, Marianne Leitsmann, MD MHBA
5, Sascha Ahyai, MD
5, Quoc-Dien Trinh, MD MBA
6, Alexander P. Cole, MD
3.
1Center for Surgery and Public Health, Brigham and Women's Hospital and Medical University of Graz, Boston, MA, USA,
2Brigham and Women's Hospital, Boston, MA, USA,
3Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA,
4Johns Hopkins University School of Medicine, Baltimore, MD, USA,
5Medical University of Graz, Graz, Austria,
6University of Pittsburgh, Pittsburgh, PA, USA.
BACKGROUND: In recent years, there has been considerable interest in addressing racial disparities in prostate cancer care including risk-adapted screening. This study examined trends in metastatic prostate cancer incidence by race and placed them in context of changes in PSA screening recommendations.
METHODS: We analyzed metastatic prostate cancer incidence trends by race (using Surveillance Epidemiology and End Results data, 2005-2021) and PSA screening trends (using Behavioral Risk Factors Surveillance Survey data, 2012-2020). We fitted a generalized linear model with an interaction term for race and year of diagnosis and calculated annual incidence rate ratios (metastatic disease) and odds ratios (screening) for Non-Hispanic Black vs. Non-Hispanic White men.
RESULTS: From 2005 to 2021, the age-adjusted metastatic prostate cancer incidence (per 100,000) increased from 16.4 to 22.3 in Non-Hispanic Black men, and from 6.2 to 10.8 in Non-Hispanic White men. While the incidence increased in both groups, the Non-Hispanic Black vs. Non-Hispanic White incidence rate ratio declined from 2.6 (95%CI:2.4,2.9) in 2005 to 2.1 (95%CI:2.0,2.2) in 2021 (p<.0001), indicating a narrowing racial gap. From 2012 to 2020, PSA screening declined in both groups. Non-Hispanic Black men initially had higher rates (OR:1.34,95%CI1.21,1.49,p<0.000) but experienced a steeper decline, resulting in no significant difference by 2020 (OR: 1.04,95%CI0.91,1.19,p=0.59).
CONCLUSIONS: The racial gap in metastatic prostate cancer narrowed over the study period, while overall incidence increased. Higher screening rates among Black men in the early 2010s may explain the narrowing racial gap in metastatic prostate cancer incidence. The subsequent, more rapid decline in screening rates among Black men raises concerns about a potential resurgence of racial disparities in the coming years.
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