Screening policy changes and prostate cancer epidemiology: 20-year trends in diagnosis, treatment, incidence, and mortality.

PURPOSE: Prostate cancer remains a major U.S. burden. We evaluated how the 2012 and 2018 USPSTF PSA recommendations affected incidence, stage at diagnosis, treatment, and mortality.

METHODS

Retrospective, population-based analysis of SEER (2004-2022), CDC WONDER (1999-2021), and GBD (1999-2021). Outcomes were age-standardized incidence and mortality (ASIR, ASMR), mortality-to-incidence ratio (MIR), and treatment patterns. Interrupted time series and joinpoint regression assessed policy effects across age, stage, race, and region.

RESULTS

From 2004 to 2022, overall ASIR declined, driven by fewer localized diagnoses, while distant-stage incidence rose, especially after 2012. The 2012 recommendation coincided with a 20.6% immediate drop in overall incidence and a 9.3% rise in metastatic disease, with partial stabilization after 2018. ASMR continued to fall but slowed during 2012-2017, then accelerated post-2018. Treatment patterns suggested a shift away from radical interventions and toward conservative management (consistent with greater use of active surveillance reported elsewhere), particularly among older men. Black men and residents of the Southern U.S. bore the highest burden and the most pronounced temporal shifts.

CONCLUSIONS

At the population level, the 2012 and 2018 USPSTF PSA screening recommendations were temporally associated with meaningful changes in U.S. prostate cancer epidemiology-reduced overall incidence (consistent with less overdiagnosis) alongside increased metastatic presentations and a transient slowing in mortality improvement; the 2018 update was associated with a partial reversal of these trends. Precision diagnostics, risk-adapted screening, and equity-focused implementation are needed to improve outcomes and reduce disparities and barriers.