42 Background: The U.S. Preventive Services Task Force (USPSTF) revised its prostate-specific antigen (PSA) screening recommendations in 2012 (Grade D, advising against routine screening) and again in 2018 (Grade C, encouraging individualized decision-making for men aged 55–69). Earlier studies showed a rise in metastatic disease after 2012, but most stopped before 2018 and lacked racial detail. Using the latest SEER data through 2022, we evaluated how prostate cancer stage at diagnosis changed across screening eras and racial groups, capturing the effect of both guideline shifts. Methods: We identified men with malignant prostate cancer (ICD-O-3 C61.9) in the SEER 17 Registries (2000–2022, November 2024 submission). Screening eras were defined as pre-2012 (Grade A/B), post-2012 (Grade D), and post-2018 (Grade C). SEER Summary Stage 2000 was grouped as localized, regional, or distant. Race and ethnicity were classified as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), American Indian/Alaska Native (NHAIAN), Asian or Pacific Islander (NHAPI), and Hispanic. Stage distributions were compared across eras and races. Results: Among 997,000 cases, localized-stage disease declined from 70.9 % before 2012 to 66.8 % after 2012 and 64.2 % after 2018, while distant-stage disease rose from 5.5 % to 6.9 % to 8.6 %. The steepest drop in localized disease occurred among NHW men (from 73 % in 2006–2007 to 62 % in 2022). NHB men had persistently higher rates of distant disease (≈ 16 %) across all eras, with minimal change following the 2018 Grade C update. Hispanic and NHAPI men showed smaller but parallel shifts. The inflection point began soon after 2012 and only partially stabilized after 2018. Conclusions: Following the 2012 USPSTF Grade D recommendation, localized prostate cancer diagnoses declined while distant-stage presentations increased across all racial groups. The 2018 Grade C revision led to only partial stabilization, and disparities—particularly among Black men—persisted. These findings underscore the long-term influence of national screening policies and support more nuanced, risk-adapted approaches to PSA screening. Temporal changes in prostate cancer stage at diagnosis by race and screening era (SEER 2005–2022). Localized (%) Distant (%) Ethnicity Pre-2012 Post-2012 Post-2018 Pre-2012 Post-2012 Post-2018 Overall 70.9 66.8 64.2 5.5 6.9 8.6 NH White 70.9 66.8 64.2 6.5 7 7.6 NH Black 13.5 15.1 15.5 16.5 15.9 16 Hispanic 9.2 10.4 10.7 11.1 11.8 13.3 NHAPI 4.9 5.2 5.7 5.8 6.2 6.9 NH: non-hispanic; NHAPI: Non-Hispanic Asian or Pacific Islander.
Kalemoglu et al. (Sun,) studied this question.