Geographic, socioeconomic and demographic inequalities in the incidence of metastatic prostate cancer at time of diagnosis in England: a population-based evaluation.

Objective: To evaluate the area-based incidence of metastatic prostate cancer at diagnosis, reflecting the risk of late-stage diagnosis, and overall prostate cancer incidence, reflecting the risk of over-diagnosis, in a country without a formal screening programme. Methods and analysis: National study of annual prostate cancer incidence between 2015 and 2019. Mixed-effects regression estimated area-based incidence, adjusted for age, ethnicity and socioeconomic deprivation. Linear regression assessed the association between metastatic and overall cancer incidence. Results: National annual incidence of metastatic prostate cancer was 5.7 per 10 000 men and overall incidence was 43.9. Higher incidence of both metastatic and overall cancer were observed in areas with older populations and with more men with black ethnicity (both p<0.0001). Greater socioeconomic deprivation was linked to higher metastatic but lower overall cancer incidence (p<0.0001). Metastatic incidence varied across the country from 4.0 to 6.8, and prostate cancer overall from 37.9 to 50.1 per 10 000 men. Areas with higher metastatic cancer incidence had lower overall cancer incidence (p<0.0001). Conclusions: There is significant geographic variation in metastatic prostate cancer incidence at diagnosis, with a higher incidence of metastatic cancer observed in areas with a lower overall prostate cancer incidence and in more socioeconomically deprived neighbourhoods, which likely contributes to poorer long-term outcomes. The findings highlight the need for a targeted, risk-based diagnostic approach as well as improved diagnostic facilities and referral pathways. Further research is needed to understand the factors driving this variation in order to reduce metastatic presentations and tackle inequalities in prostate cancer outcomes.