Prostate Cancer Incidence and Survival, by Stage and Race/Ethnicity

United States, 2001-2017

David A. Siegel, MD; Mary Elizabeth O'Neil, MPH; Thomas B. Richards, MD; Nicole F. Dowling, PhD; Hannah K. Weir, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2020;69(41):1473-1480. 

In This Article

Abstract and Introduction

Introduction

Among U.S. men, prostate cancer is the second leading cause of cancer-related death.[1] Past studies documented decreasing incidence of prostate cancer overall since 2000 but increasing incidence of distant stage prostate cancer (i.e., signifying spread to parts of the body remote from the primary tumor) starting in 2010.[2,3] Past studies described disparities in prostate cancer survival by stage, age, and race/ethnicity using data covering ≤80% of the U.S. population.[4,5] To provide recent data on incidence and survival of prostate cancer in the United States, CDC analyzed data from population-based cancer registries that contribute to U.S. Cancer Statistics (USCS).* Among 3.1 million new cases of prostate cancer recorded during 2003–2017, localized, regional, distant, and unknown stage prostate cancer accounted for 77%, 11%, 5%, and 7% of cases, respectively, but the incidence of distant stage prostate cancer significantly increased during 2010–2017. During 2001–2016, 10-year relative survival for localized stage prostate cancer was 100%. Overall, 5-year survival for distant stage prostate cancer improved from 28.7% during 2001–2005 to 32.3% during 2011–2016; for the period 2001–2016, 5-year survival was highest among Asian/Pacific Islanders (API) (42.0%), followed by Hispanics (37.2%), American Indian/Alaska Natives (AI/AN) (32.2%), Black men (31.6%), and White men (29.1%). Understanding incidence and survival differences by stage, race/ethnicity, and age can guide public health planning related to screening, treatment, and survivor care. Future research into differences by stage, race/ethnicity, and age could inform interventions aimed at improving disparities in outcomes.

Cases included males with malignant prostate cancer§ and excluded cases diagnosed by autopsy and death certificate only. Incidence data were from USCS during the period 2003–2017 and covered 100% of the U.S. population. Age-adjusted rates were expressed per 100,000 men. Trends in incidence were described using annual percent change (APC) and average annual percent change (AAPC) calculated by joinpoint regression. Statistically significant APC and AAPC were different from zero (p<0.05).** Survival data were from CDC's National Program of Cancer Registries (NPCR)–funded registries that conducted active case follow-up or linkage with CDC's National Death Index, and covered 94% of the U.S. population.†† Survival analysis included cases diagnosed during 2001–2016 with follow-up through December 31, 2016. Relative survival (cancer survival in the absence of other causes of death) was calculated§§ for 1, 5, and 10 years after diagnosis, using expected life tables stratified by age, sex, race/ethnicity, socioeconomic status, geographic location, and calendar year of diagnosis.¶¶ Differences between relative survival estimates were determined by comparing 95% confidence intervals (CIs), which allowed for an informal, conservative comparison of estimates. Differences in relative survival were noted when CIs did not overlap.

Incidence and survival were stratified by stage, age, year of diagnosis, and race/ethnicity. There were four categories for race (Black, White, AI/AN, and API) and one for ethnicity (Hispanic). Men categorized by race were all non-Hispanic. Men categorized as Hispanic might be of any race. Stage was defined using Summary Stage, the staging system used by the cancer surveillance community and defined with the following categories: localized (tumor is confined to the organ of origin without extension beyond the primary organ), regional (direct extension of the tumor to adjacent organs or structures or spread to regional lymph nodes), distant (cancer has spread to parts of the body remote from the primary tumor), and unknown.***

During 2003–2017, a total of 3,087,800 new cases of prostate cancer were diagnosed in the United States (Table 1). Over this 15-year period, age-adjusted incidence decreased from 155 per 100,000 in 2003 to 105 in 2017 (Supplementary Table 1, https://stacks.cdc.gov/view/cdc/94592). During 2003–2017, incidence was highest for men aged 70–74 years (764) and Black men (202). Localized, regional, distant, and unknown stage prostate cancer accounted for 77%, 11%, 5%, and 7% of total cases, respectively. The percentage of localized cases decreased from 78% in 2003 to 70% in 2017, and distant cases increased from 4% in 2003 to 8% in 2017. White men had lower percentages of distant (5%) and unknown stage (6%) prostate cancer than did any other race/ethnicity. The overall incidence of prostate cancer decreased during 2003–2017 (AAPC = −2.5%) but increased for cases diagnosed at distant stage (AAPC = 2.2%). More specifically, the increase was observed during 2010–2017 (APC = 5.1%) and began in 2011 or earlier, regardless of race/ethnicity.

During 2001–2016, among 3,104,380 men with survival data, 5-year and 10-year relative survival was 97.6% and 97.2%, respectively (Table 2). Men aged ≤49 years and ≥80 years had the lowest 10-year relative survival (95.6% and 82.7%, respectively). For localized prostate cancer, 10-year relative survival was 100%. Ten-year relative survival for regional, distant, and unknown stage was 96.1%, 18.5%, and 78.1%, respectively. For distant stage prostate cancer, 10-year relative survival was highest for ages 60–64 years (21.8%) and was <20% for ages <55 and ≥70 years.

Comparing 2001–2005 with 2011–2016, 5-year relative survival improved from 97.5% to 99.3% for regional stage and from 28.7% to 32.3% for distant stage prostate cancer (Table 3). During 2001–2016, 5-year survival for distant stage prostate cancer was highest among API (42.0%), followed by Hispanics (37.2%), AI/AN (32.2%), Black men (31.6%), and White men (29.1%). Survival by race/ethnicity showed differences by age (Supplementary Table 2, https://stacks.cdc.gov/view/cdc/94593). For unknown stage prostate cancer, 5-year survival was higher for Hispanic (84.4%) and White men (82.8%) than Black men (79.1%).

*https://www.cdc.gov/cancer/uscs.
https://www.cdc.gov/cancer/uscs/public-use/dictionary/behavior-code-ICD-O-3.htm.
§ https://seer.cancer.gov/siterecode/icdo3_dwhoheme/index.html.
Rates were adjusted to the 2000 U.S. standard population.
**A maximum of two joinpoints were used to determine a change in direction of trend.
††Registries met USCS publication criteria and included all U.S. states and the District of Columbia except for Connecticut, Hawaii, Indiana, Iowa, Kansas, and New Mexico.
§§The cohort method was used to estimate survival when all patients had a full 1, 5, and 10 years of follow-up. The complete method was used when not all patients had the full 5 or 10 years of follow-up for 5-year and 10-year survival time estimates. https://surveillance.cancer.gov/survival/cohort.html.
¶¶ https://www.seer.cancer.gov.
***Defined by merged Summary Stage. https://www.cdc.gov/cancer/uscs/public-use/dictionary/merged-summary-stage.htm and https://training.seer.cancer.gov/collaborative/intro/systems_review.html.

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