The Evolution of Prostate Cancer Presentation in the United States.

OBJECTIVES: As for other cancers, there may have been changes to prostate cancer presentation in terms of aggressiveness and extent of disease. METHODS: Patients with prostate adenocarcinoma from 2004 to 2022 in the National Cancer Database (NCDB) and 2013 to 2018 in the Surveillance, Epidemiology, and End Results (SEER)-Decipher linked database were evaluated. We estimated age-adjusted incidence of elevated PSA (>10), high-grade prostate cancer (Gleason score of 4+4 and higher), metastatic prostate cancer, and trend in recorded Decipher GC score. RESULTS: The age adjusted proportion of patients who presented with a PSA >10 ng/dL declined from 2002 to 2009 and then rose. The proportion of patients who presented with high-grade cancer was stable from 2004 to 2008, increased from 2008 to 2015, and stabilized from 2015 to 2022. The proportion presenting with metastatic prostate cancer increased starting around 2007. GC score declined from 2010 to 2013, increased rapidly from 2013 to 2016, and then continued to rise at a slower pace from 2016 to 2018. CONCLUSIONS: There has been a nationwide increase in metastatic and aggressive prostate cancer.