- Prostate cancer diagnoses increased by 3% per year from 2014 to 2021, with the sharpest increase seen in advanced-stage disease.
- Prostate cancer mortality rates have continued to decline, but at a lower rate over the past decade.
- Racial disparities in prostate cancer incidence and mortality persist, with Black men dying of the disease at twice the rate of white men.
After years of declining rates, prostate cancer diagnoses increased by 3% per year from 2014 to 2021, with the steepest rise seen in advanced disease, according to a report from the American Cancer Society (ACS).
While new diagnoses of prostate cancer fell by 6.4% per year from 2007 to 2014, diagnoses increased by 2.4% annually for localized-stage disease, 4.6% annually for regional-stage disease, and 4.8% annually for distant-stage disease between 2017 and 2021, with trends varying by age group, reported Tyler B. Kratzer, MPH, and ACS colleagues in CA: A Cancer Journal for Clinicians.
At the same time, the decline in rates of prostate cancer mortality slowed from 3% to 4% per year during the 1990s and 2000s to 0.6% per year over the past decade, with substantially higher mortality rates among Black men versus white men.
"Our research highlighting the continued increases in prostate cancer incidence and persistent racial disparities underscores the need for redoubled efforts to understand the etiology of prostate cancer and optimize early detection," said Kratzer in a press release.
Co-author Ahmedin Jemal, DVM, PhD, told MedPage Today that there could be a link between the U.S. Preventive Services Task Force (USPSTF) recommendations against prostate-specific antigen (PSA)-based screening for prostate cancer in 2008 and 2012, and the observed increase in advanced prostate cancer diagnoses.
The rationale behind the USPSTF recommendation was to reduce overdiagnosis and avoid unnecessary treatments that could lead to harmful side effects such as incontinence and erectile dysfunction. However, Kratzer and team noted that these recommendations against PSA testing "coincided with an increase in advanced prostate cancer diagnoses that has continued through 2021, despite advances in more nuanced screening and disease management."
PSA screening peaked in 2008 at 44% before declining to 34% in 2013, and a number of studies have suggested that there is a connection between declining PSA testing rates and increases in advanced-stage prostate cancers.
For example, a 2022 study suggested that a decline in PSA screening rates in men treated in Veterans Health Administration facilities was associated with increased rates of metastatic prostate cancer.
The USPSTF has since issued revised recommendations saying that screening should be an individual decision for men between the ages of 55 and 69 in consultation with their physicians, and should be avoided in men ages 70 and over.
"Patients should be told about the benefits -- as well as the risks -- associated with screening, but this informed decision making may not be happening," Jemal said. "As a result, the uptake in screening is low, which may have contributed to the increase in late-stage diagnoses. There has to be an awareness about the importance of having this conversation about prostate cancer screening with clinicians."
He suggested that -- per ACS guidelines -- starting at age 50, men should discuss the benefits and harms of screening with their healthcare providers, and Black men and those with a family history of prostate cancer should have that conversation at age 45.
There will be an estimated 313,780 new cases of prostate cancer and 35,770 prostate cancer deaths in the U.S. in 2025, the researchers noted. An estimated 3.5 million men in the U.S. had a history of prostate cancer as of Jan. 1, 2022, which was over four times higher than for any other cancer in men.
Rates of distant-stage disease diagnoses increased in men of all ages, ranging from 2.6% to 2.9% per year in men ages 20 to 54 to 5% per year in men ages 55 and older.
However, rates of localized-stage disease diagnoses increased only in men 70 and over -- an age group in which PSA testing may be increasing -- while they decreased in men younger than 40.
Regional-stage disease diagnosis rates also decreased in young men and were stable in those ages 40 to 54, but increased in men ages 55 to 69 by 3.4% annually and in older men by 7.5% annually.
Black men had the highest prostate cancer incidence rate of any racial or ethnic group -- 67% higher than that of white men. The difference in mortality rates was even more pronounced, with rates among Black men nearly double those of any other racial or ethnic group.
However, declines in prostate cancer mortality have been steeper among Black men than among white men (2.9% vs 1.9% per year) since 2001, with rates among white men declining by only 0.2% per year since 2012.
As a result, the disparity between Black and white men in prostate cancer mortality has declined from a peak of a 2.5 times higher rate in Black men in 2001 to a two times higher rate in 2023, although that is still a much wider gap than the disparity in incidence between the two groups.
"Reasons for racial disparities in incidence are unclear but to some extent include genetic factors associated with African ancestry, perhaps moderated by epigenetic factors related to the social determinants of health, and yet unknown environmental and age-related factors," the authors wrote. They suggested that differences between races in PSA testing prevalence could also be a factor.
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