Prostate Cancer, 2001–2017: Fewer Cases Overall, More Found After It Has Spread

Prostate cancer is the second leading cause of cancer death among U.S. men. Earlier studies found overall incidence falling since 2000, but distant-stage cases — cancer that has spread to parts of the body far from the tumor — rising from 2010. Using U.S. Cancer Statistics, which covered 100% of the population for incidence and 94% for survival, CDC brought the picture up to date.

Stages

Incidence, 2003–2017

• 3,087,800 new cases were diagnosed.
• Age-adjusted incidence fell from 155 per 100,000 men in 2003 to 105 in 2017 (an average 2.5% a year).
• Incidence was highest among men aged 70–74 (764) and Black men (202).
• Distant-stage incidence rose: an average 2.2% a year overall, and 5.1% a year during 2010–2017, beginning by 2011 in every racial and ethnic group.
• Localized cases fell from 78% of diagnoses in 2003 to 70% in 2017; distant cases rose from 4% to 8%.
• White men had the lowest shares of distant (5%) and unknown-stage (6%) cancer.

Survival, 2001–2016

Relative survival is survival from the cancer in the absence of other causes of death.

• Improving: 5-year survival rose from 2001–2005 to 2011–2016 — for regional stage from 97.5% to 99.3%, and for distant stage from 28.7% to 32.3%. Still, fewer than one in three men with distant-stage cancer survive five years.
• By age: 10-year survival was lowest for men 49 and younger (95.6%) and 80 and older (82.7%). For distant-stage cancer it peaked at ages 60–64 (21.8%) and was under 20% below 55 and from 70 on.

Distant-stage 5-year survival by race and ethnicity

For all stages together, White men had higher 5-year survival than Black or Hispanic men; for unknown stage, Hispanic (84.4%) and White (82.8%) men fared better than Black men (79.1%).

What might explain the trends

• Screening advice. In 2012 the U.S. Preventive Services Task Force recommended against PSA-based screening for men of all ages, judging the harms to outweigh the benefits. That likely helped lower reported incidence, and may have contributed to the rise in distant-stage cancer. In 2018 it changed course: for men aged 55–69, screening should be an individual decision weighing benefits and harms, and professional groups also recommend shared decision-making.
• Better treatment. New hormone and antibody therapies may explain improving distant-stage survival — but the rise in distant-stage cases may have helped stall the earlier decline in prostate cancer deaths during 2013–2017.
• Localized cancer still weighs on men. 130,658 to 190,570 new cases were diagnosed each year even as localized incidence fell; many need surgery or radiation, which can leave long-term effects such as incontinence and erectile dysfunction, and up to 6% progress to metastatic disease.
• Disparities. Social inequities by race contribute to worse outcomes for Black men; the unknown-stage group may include men too unwell for staging, men without access to care, or incomplete records. Men 49 and younger have seen rising incidence over three decades and lower survival, perhaps reflecting tumor behavior, genetics, family history or treatment.

Limits

Missing cases and reporting delays could undercount incidence, especially in recent years; a staging system used from 2003 to 2015 may explain fewer unknown-stage cases then; and survival shown as 100% means only that no excess deaths were seen.

Sources

Based on Siegel DA, O'Neil ME, Richards TB, Dowling NF, Weir HK, "Prostate Cancer Incidence and Survival, by Stage and Race/Ethnicity — United States, 2001–2017," MMWR volume 69, number 41, Centers for Disease Control and Prevention; a work of the United States government in the public domain.