The incidence of localized prostate cancer has declined with shifts in prostate cancer screening. While recent population-based studies demonstrate a stable incidence of loco-regional prostate cancer, this categorized organ-confined, extra-prostatic and lymph node positive disease together. The contemporary incidence of prostate cancer with pelvic lymph node metastases (PLNM) however, remains unknown.
We used Surveillance, Epidemiology and End Results (SEER) from 2004 to 2014 to identify men diagnosed with prostate cancer. We analyzed trends in the age-standardized prostate cancer incidence by stage. Impact of extent of disease on mortality was assessed by adjusted-Cox proportional hazard analysis.
During the study period, the annual incidence of non-metastatic prostate cancer declined from 5119.1 per million to 2931.9 per million (Incidence ratio [IR]: 0.57, 95% confidence interval [CI]: 0.56-0.58, p<0.01), while PLNM increased from 54.1 per million to 79.5 per million (IR: 1.47, 95%CI: 1.33-1.62, p<0.01). The incidence of distant metastases in men aged 75 years and over nadired in 2011 compared to 2004 (IR: 0.81, 95%CI: 0.74-0.90, p<0.01), and increased in 2012 (IR: 1.13, 95%CI: 1.02-1.24, p<0.05) compared to 2011. Risk of cancer specific mortality was significantly increased in men diagnosed with PLNM (hazard ratio [HR]: 4.5, 95% confidence interval [CI]: 4.2-4.9, p<0.01) and distant metastases (HR: 21.9, 95% CI: 21.2-22.7, p<0.01) compared to non-metastatic disease.
The incidence of PLNM is increasing, coincident with a decline in detection of localized disease. Whether this portends an increase in the burden of advanced disease or simply reflects diminished lead-time remains unclear. However, this should be monitored closely, as the increase in N1 disease reflects an increase in incurable prostate cancer at diagnosis.
The Journal of urology. 2017 Dec 26 [Epub ahead of print]
Adrien N Bernstein, Jonathan E Shoag, Ron Golan, Joshua A Halpern, Edward M Schaeffer, Wei-Chun Hsu, Paul L Nguyen, Art Sedrakyan, Ronald C Chen, Scott E Eggener, Jim C Hu
Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY., Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL., Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY., Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA., Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC., Division of Urology, The University of Chicago Medicine, Chicago, IL., Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY. Electronic address: .