Rising metastatic prostate cancer rates but narrowing racial gap

In recent years, there has been considerable interest in addressing racial disparities in prostate cancer (PCa) care including risk-adapted screening. This study examined trends in metastatic PCa incidence by race and placed them in context of changes in PSA screening recommendations.

We analyzed metastatic PCa 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 (NHB) vs. Non-Hispanic White (NHW) men.

From 2005 to 2021, the age-adjusted metastatic PCa incidence (per 100,000) increased from 16.4 to 22.3 in NHB men, and from 6.2 to 10.8 in NHW men. While the incidence increased in both groups, the NHB vs. NHW 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. NHB men initially had higher rates (OR:1.34, 95%CI: 1.21, 1.49, p < 0.0001) but experienced a steeper decline, resulting in no significant difference by 2020 (OR: 1.04, 95% CI: 0.91, 1.19, p = 0.59).

The racial gap in metastatic PCa narrowed over the study period, while overall incidence increased. Higher screening rates among Black men in the early 2010s may explain the narrowing gap. The subsequent more rapid decline among Black men raises concerns about resurgence of racial disparities in the coming years.