Incidence of High-Risk Prostate Cancer in Korea: Insights From Real-World Data Between 2010 and 2020

Background: This study aims to report the nationwide risk stratification of prostate cancer (PCa) over the past decade-an analysis that has not been previously conducted, as such data are not available through the medical insurance-based big data registry of South Korea.Methods: Nationwide data on the clinicopathologic variables of PCa at the time of diagnosis through biopsy, prostate-specific antigen (PSA) levels, clinical stage, Gleason grade, and residential area of the patient were obtained from 51 general hospitals (with 200 beds) across South Korea in 2010, 2012, 2014, 2016, 2018, and 2020.The risk criteria were based on universal guidelines defined in the 2010s, with high risk defined as PSA levels > 20 ng/mL, clinical stage cT3a, and Gleason group (GG) 4; low risk was defined as PSA levels < 10 ng/ mL, clinical stage cT2a, and GG < 1. Results: Data from 27,075 cases, representing 37.9% of the 71,403 patients registered in the National Cancer Statistics during the study period, were obtained from 51 hospitals.High-risk PCa (50.6%) was the most prevalent disease during the study period, while the proportion of low-risk diseases, including potential low-risk cases, decreased from 11.4% in 2010 to 7.6% in 2020.High-risk PCa was most prevalent in 9 of the 17 administrative regions, with 55.4% of high-risk cancer cases originating in rural areas compared to 47.7% from urban areas (P < 0.0001). Conclusion:Approximately 50% of the patients with PCa detected in South Korea in the 2010s had high-risk disease, which was a consistent nationwide.The higher prevalence of low-risk disease among residents of the capital metropolitan area, compared to the higher frequency of high-risk disease among rural residents, suggests disparities in access to early PCa detection and diagnosis.