A Comparison of Prostate Cancer Incidence and Mortality Rates in the Veterans Affairs Healthcare system and the Surveillance, Epidemiology, and End Results Program

BACKGROUND: Men seeking care in the Veterans Health Administration (VHA) may have higher prostate cancer (PCa) incidence, metastases, and mortality (PCSM) relative to the general US population due to military exposures and increased access to care. We compared rates in both populations using contemporary databases. METHODS: Annual PCa incidence, metastasis, and PCSM rates between 2008 and 2022 were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program and calculated from the VA Multi-OMICS Analysis Platform for Prostate Cancer (VA-MAPP) database. Age-adjusted rates per 100,000 were standardized to the veteran's age distribution and stratified by race/ethnicity and age group (<50, 50-64, 65+ years). Joinpoint regression was used to evaluate trends in rates following changes in United States Preventive Services Task Force (USPSTF) screening recommendations. RESULTS: PCa incidence and PCSM rates were higher in the VHA vs SEER (RR2018-2022: 3.34, 95% CI: 3.32-3.36). However, metastatic rates were lower in the VHA compared to SEER (RR2018-2022: 0.69, 95% CI: 0.67-0.71). PCa incidence declined in the VHA (APC2008-2011: 7.3, 95% CI: 5.0-9.6) and SEER (APC2008-2011: 3.2, 95% CI: 0.7-5.6) prior to USPSTF 2012 guidelines, but metastatic rates increased in the VHA (APC2012-2017: 4.6, 95% CI: 2.1-7.1) and SEER (APC2012-2017: 3.3, 95% CI: 1.5-5.3), followed by general flattening of incidence, metastasis, and PCSM in both groups. CONCLUSIONS: Higher PCa incidence and PCSM was observed in VHA compared to SEER, but not metastasis. IMPACT: Increased access to care could explain higher incidence but more favorable metastatic presentation in VHA compared to SEER.