Incidence of prostate cancer increases in California following change in screening guidelines

Incidence of prostate cancer increases in California following change in screening guidelines

After a change in screening guidelines, the incidence increased statewide, even more than nationally.

The incidence of advanced prostate cancer in California rose in the decades since doctors quit, according to a new study from UC San Francisco.

After many years, the disease's mortality rate is also declining in most regions across the state.

The findings reinforce the need for screening that can identify potentially deadly tumors without raising false alarms about those that pose no threat to the patient.

The study will be published on January 27thJama Network Open.

This overall increasing trend is alarming and has occurred across age groups, regions of California, and racial and ethnic groups. “

Erin L. Van Blarigan, SCD, senior author, UCSF Associate Professor of Epidemiology & Biostatistics and Urology

“Our data points to how urgent this problem is,” said Van Blarigan, who is also the UCSF Helen Diller Comprehensive Cancer Center. "The best way to screen for prostate cancer continues to be a challenge for researchers and physicians. Without screening, the number of men diagnosed with advanced prostate cancer - when treatments are less effective - is increasing rapidly."

The challenge of screening for prostate cancer

Prostate cancer is the most common cancer among men in the United States and the second leading cause of cancer deaths. While some tumors are aggressive and can cause death, the majority are low grade and never spread.

The most commonly used screening tool is the PSA (prostate specific antigen) test, which does not differentiate between aggressive or non-aggressive tumors, resulting in many men being diagnosed with cancers that would not harm them in the long term.

On the other hand, timely diagnosis of advanced cancers can be missed - these cancers may have been successfully treated if they were found early.

After years of screening all men for prostate cancer, the U.S. Task Force stopped screening all men for prostate cancer in 2012. They hoped to prevent unnecessary and potentially harmful interventions such as surgery for men whose illness was not serious.

In 2018, she recommended that men ages 55 to 69 discuss potential benefits and harms of screening with their doctors. But as the authors note, this may not always happen.

Prostate cancer mortality stops falling

UCSF researchers analyzed data involving nearly 388,000 men with prostate cancer in California between 2004 and 2021. Nearly 28,000 (7.2%) had advanced disease, which has a five-year survival rate of just 37%. There were 58,754 prostate cancer deaths during the study period.

Investigators looked at 10 regions spanning the state to determine whether rates were increasing faster or slower in certain areas.

They found that major diseases that were stable or declining through 2010 grew 6.7% per year from 2011 to 2021. In contrast, national rates grew by 4.5% per year from 2011 to 2019. The lowest annual increase was in the southern San Joaquin Valley (2.3%), with the highest on the Central Coast (9.1%).

Prostate cancer mortality fell by 2.6% per year between 2004 and 2012; But after that, it plateaued in 7 out of 10 regions of the state. Mortality was highest in the Inland Empire, followed by San Diego-Imperial and North Coast. It was lowest in the San Francisco Bay Area.

“It is important to continue to monitor prostate cancer trends both in California and nationally as we learn more about the impact of screening policies on different populations,” said senior author Scarlett L. Gomez, MPH, UCSF professor in the Department of Epidemiology and Biostatistics.

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