Trends in age and prostate-specific antigen at prostate cancer diagnosis between 2010 and 2019

Recent studies have shown that de novo metastatic prostate cancer incidence in the United States increased from 2010 to 2019. Plausible explanations include delayed detection after recommendations against prostate cancer screening or upstaging associated with use of more sensitive imaging technologies. Using Surveillance, Epidemiology, and End Results patient cases and controlling for aging of the population, we found the median age and prostate-specific antigen (PSA) level at prostate cancer diagnosis increased by 1.4 years of age (95% CI = 1.3 to 1.5 years) and 1.4 ng/mL (95% CI = 1.4 to 1.5 ng/mL) over this period, consistent with the delayed detection hypothesis. Racial differences were noted, with 75th percentiles of PSA at diagnosis increasing by 4.3 ng/mL (95% CI = 3.7 to 4.8 ng/mL) over this time period for non-Hispanic Black men compared with 3.0 ng/mL (95% CI = 2.8 to 3.2 ng/mL) for non-Hispanic White men. Overall, patient characteristics at diagnosis suggest that delayed detection contributed at least in part to increases in de novo metastatic disease.