Temporal evolution of prostate cancer incidence and incidence-based mortality from 2000 to 2022: A retrospective analysis by race and age at diagnosis based on USPSTF screening guidelines.

5124 Background: Prostate-specific antigen (PSA) screening guidelines have evolved substantially since 2000, influencing detection patterns and outcomes. Despite widespread implementation, significant racial disparities persist in prostate cancer incidence and mortality. Understanding temporal trends across guideline eras, stratified by race and age, is critical for optimizing screening strategies and addressing health equity. Methods: Using SEER*Stat, we extracted data from the Surveillance, Epidemiology, and End Results (SEER) database (2000–2022). We employed Jointpoint regression to analyze the secular trend in incidence and incidence-based mortality (IBM), which we classified and arranged by race, age at diagnosis, and year of diagnosis. Annual percentage change (APCs) were calculated using weighted least square method. Results: A total of 1,259,662 patients met the inclusion criteria for our study. These included diagnosed cases of prostate cancer from 2000-2022. The total age-adjusted incidence rate was 60.7 per 100,000. The APC from 2000-2007 (before 2008 guidelines) was -0.1 (p < 0.05), signifying a cumulative annual decrease. The APC was -2.6 (p < 0.05) from 2008-2011, 0.1 (p < 0.05) from 2012-2017, and 1.5 (p < 0.05) from 2018-2022. Based on race, the APC from 2000-2022 was -2.1 for white, -1.7 for blacks, -2.2 for American Indian/Alaska native (AIAN) and -2.7 for asian and pacific islander (API). Based on age at diagnosis, the APC was -1.9 from 55-64 years, -1.7 from 65-74 years, -2.0 from 75- 84 years, and -2.2 at 85 years and above. In terms of incidence based mortality, rate increased from 2.4 (2000) to 37.7 (2022) in white, with APC of 6.3% (95% CI 5.0–7.7), in black, rate increased from 4.8 (2000) to 60.5 (2022), with APC of 5.2% (95% CI 4.0– 6.4), in API, rate increased from 1.8 (2000) to 17.7 (2022) while in AIAN, rate increased from 2.4 (2000) to 21.5 (2022), with APC of 5.0% (95% CI 3.4–6.6). Conclusions: Between 2000 and 2022, prostate cancer incidence demonstrated distinct temporal patterns aligned with changes in PSA screening recommendations, with a marked decline from 2008 to 2011, minimal change from 2012 to 2017, and an increase from 2018 to 2022. Across the same period, incidence-based mortality (IBM) increased steadily in all racial groups, despite long-term declines in overall incidence. Incidence-based mortality rates were consistently higher in black patients compared with white patients throughout the study period. These findings demonstrate a difference between incidence and incidence-based mortality over time and highlight persistent racial differences in prostate cancer outcomes across multiple screening eras.