Trends in Prostate Cancer Incidence and Survival by Gleason Score from 2000 to 2020: A Population-Based Study in...

Prostate cancer (PCa) trends have evolved due to changing screening practices. This study assessed long-term trends in PCa incidence and survival according to Gleason score (GS) in Friuli Venezia Giulia, northeastern Italy.

A population-based study was conducted, encompassing 21,571 PCa cases from the regional Cancer Registry, diagnosed between 2000 and 2020. Age-standardized incidence rates and 5-year overall (OS) and net survival (NS) were assessed by GS (2-6, 7, 8-10) and age group (<65, 65-74, ≥75). Trends were analyzed using Joinpoint regression.

PCa incidence increased from 2000 to 2007 (Annual Percent Change, APC = +1.8%), then declined sharply until 2010 (APC = -7.6%) and remained stable thereafter. Incidence of low-grade cancers (GS 2-6) decreased across all age groups, especially in men aged ≥ 75 years (APC = -8.1%). The incidence of GS 7 rose until 2007 and then stabilized. High-grade cancers (GS 8-10) showed a stable incidence, but their proportion increased from 20% to 29%, mainly in older men. Survival improved across all GS groups. For GS 2-6, OS increased from 81.4% to 88.2%; for GS 7, from 78.1% to 88.1%. GS 8-10 had smaller gains, but NS reached 82% in recent years. Among men aged ≥ 75 years, OS for GS 7 rose from 51.9% to 78.1%, and for GS 8-10, from 43.9% to 54.4%. NS remained high for GS ≤ 7.

While overall outcomes improved, the increasing proportion of high-grade PCa, despite a stable incidence, raises concerns, particularly in older men, and calls for tailored clinical strategies.