A SEER-based Joinpoint analysis investigating the effect of shared decision-making on prostate cancer stage at diagnosis.

10521 Background: Prostate cancer screening recommendations in the United States have evolved over the last two decades. The U.S. Preventive Services Task Force (USPSTF) recommended against routine prostate-specific antigen (PSA) screening for men ≥75 in 2008 and for all men in 2012 (Grade D), followed by a transition to shared decision-making for men ages 55–69 in 2018 (Grade C). These changes have raised concern for later-stage presentation Few analyses have leveraged national data through 2022 to evaluate whether the 2018 guideline modification has affected stage-specific incidence. Methods: We queried the Surveillance, Epidemiology, and End Results (SEER) Program for malignant prostate cancer cases diagnosed from 2000–2022 using the SEER 17 Registries Research Data (November 2024 submission), which provides population-based incidence coverage for approximately 26% of the United States. Cases were limited to men aged ≥55 at diagnosis. Age-adjusted incidence rates (per 100,000; 2000 U.S. standard population) were extracted separately for localized and distant Prostate malignancies (Summary Stage 2000+) using SEER*Stat incidence rate sessions. Annual rates and standard errors were exported for analysis. Joinpoint regression (Joinpoint v5.4.0) was used to estimate Annual Percent Change (APC) for each trend segment, with model selection determined by the Bayesian Information Criterion and weighting by standard error. Up to four joinpoints were permitted, and the software automatically selected the optimal number. Average Annual Percent Change (AAPC) was calculated to summarize overall trends. Results: Localized prostate cancer incidence declined significantly from 2004–2022 (APC = –3.12%; p < .05). Distant prostate cancer incidence decreased from 2000–2010 (APC = –0.95%; p < .05), followed by a significant increase from 2010–2022 (APC = +6.04%; p < .05). Joinpoint analysis identified a statistically significant inflection point near 2010 that temporally follows USPSTF recommendations discouraging routine PSA screening. No additional joinpoint or attenuation in distant-stage incidence was observed following the 2018 guideline revision. Conclusions: Using up-to-date national registry data through 2022, our analysis corroborates prior work demonstrating rising distant-stage prostate cancer incidence following guideline changes that reduced PSA screening. The absence of a joinpoint following the 2018 revision suggests that the shift to shared decision-making has not yet reversed or slowed this trend.