After a change in screening guidelines, the incidence increased across the state, surpassing the national trend.
A new study from UC San Francisco reports a significant increase in advanced prostate cancer cases in California over the past decade, following the decline of routine screenings for all men.
After years of decline, the prostate cancer death rate has also leveled off in most regions of the state.
The findings highlight the importance of screening methods that can detect life-threatening tumors while minimizing unnecessary concerns about harmless ones.
The study was published on January 27 in JAMA Network Open.
“This overall rising trend is alarming and has occurred across age groups, regions of California, races, and ethnicities,” said lead author Erin L. Van Blarigan, ScD, UCSF associate professor of Epidemiology & Biostatistics and Urology.
“Our data point to how urgent this problem is,” said Van Blarigan, who is also with the UCSF Helen Diller Family Comprehensive Cancer Center. “Figuring out the best way to screen for prostate cancer continues to be a challenge for researchers and doctors. Without screening, the number of men diagnosed with advanced prostate cancer – when treatments are less effective – increases fast.”
The challenge of screening for prostate cancer
Among men in the U.S., prostate cancer is the most common cancer and the second-leading cause of cancer deaths. While some tumors are aggressive and can lead to death, the majority are low-grade and never spread.
The most frequently used screening tool is PSA testing (prostate-specific antigen), which does not differentiate between aggressive or non-aggressive tumors, leading many men to be diagnosed with cancers that would not hurt them in the long run.
On the other hand, if screening isn’t done, timely diagnosis of more advanced cancers can be missed – those cancers might have been successfully treated if found early.
After years of screening all men for prostate cancer, the U.S. Preventative Services Task Force stopped recommending it in 2012. They hoped to prevent unnecessary and potentially harmful interventions, like surgery, for men whose disease was not serious.
In 2018, they began recommending that men between the ages of 55 and 69 discuss the possible benefits and harms of screening with their doctors. But, as the authors note, this may not always be happening.
Prostate cancer mortality stops falling
UCSF researchers analyzed data involving nearly 388,000 men with prostate cancer in California between 2004 and 2021. Almost 28,000 (7.2%) had advanced disease, which has a five-year survival rate of just 37%. During the study timeframe, there were 58,754 deaths from prostate cancer.
Investigators looked at 10 regions spanning the state to see if rates in certain areas were increasing faster or slower.
They found that serious disease, which had been stable or dropping until 2010, grew 6.7% a year from 2011 to 2021. By contrast, national rates grew by 4.5% a year from 2011 to 2019. The lowest annual increase was in the Southern San Joaquin Valley (2.3%), the highest was in the Central Coast (9.1%).
Prostate cancer mortality dropped by 2.6% a year between 2004 and 2012; but after that, it plateaued in 7 out of 10 regions in the state. Mortality was highest in the Inland Empire followed by San Diego-Imperial and North Coast. It was the lowest in the San Francisco Bay Area.
“It’s important to continue monitoring prostate cancer trends both in California and nationally as we learn more about the impact of screening guidelines on different populations,” said senior author Scarlett L. Gomez, PhD, MPH, UCSF professor in the Department of Epidemiology & Biostatistics.
Reference: “Trends in Prostate Cancer Incidence and Mortality Rates” by Erin L. Van Blarigan, Meg A. McKinley, Samuel L. Washington, Matthew R. Cooperberg, Stacey A. Kenfield, Iona Cheng and Scarlett L. Gomez, 27 January 2025, JAMA Network Open.
DOI: 10.1001/jamanetworkopen.2024.56825
Funding: California Department of Public Health; Centers for Disease Control and Prevention’s National Program of Cancer Registries (1NU58DP007156); the National Cancer Institute’s Surveillance, Epidemiology and End Results Program (HHSN2612018000321, HHSN2612018000151, HHSN2612018000091).
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2 Comments
My opinion is that under no circumstances are the wealthy, powerful and elite or those who actually care to live a long life going to allow their choices to be limited. These “guidelines” to prevent anxiety amongst the disposable classes are just that, guidelines. They’re not worth a thing and should be ignored by men. Being a man means tending to one’s health and one’s future, regardless of what the bean counters tell you to do.
To me the important question regards the potential causes. What are the possibilities? Many avenues need to be investigated. Quite curious.