Prostate Cancer Is Rising Again. What Men Should Know About Screening

Prostate cancer is common, but the most important question for men is not simply how common it is. It is when the cancer is found and whether it has spread.

The American Cancer Society estimates that 333,830 men in the United States will be diagnosed with prostate cancer in 2026, and 36,320 will die from it. About 1 in 8 men will be diagnosed with prostate cancer during their lifetime. After falling sharply between 2007 and 2014, the U.S. incidence rate increased about 3% a year from 2014 through 2022.

But California has another part of the story that deserves attention: more prostate cancers are being diagnosed after they have already spread.

California is seeing more distant-stage prostate cancer

A study of California Cancer Registry data covering nearly 388,000 prostate cancer cases from 2004 through 2021 found that the incidence of distant-stage prostate cancer increased an average of 6.7% a year from 2011 through 2021.

Among Hispanic men, the increase was about 8% a year from 2014 through 2021. The researchers also found that California’s prostate cancer death rate, which had declined from 2004 through 2012, essentially plateaued from 2012 through 2021.

The findings do not establish one reason for the increase in advanced disease. They do, however, make the question of early detection particularly important.

Why stage matters

Prostate cancer can have very different outcomes depending on how far it has spread.

Current National Cancer Institute SEER data show an overall five-year relative survival rate of 98.2% for prostate cancer. But the number changes dramatically by stage.

About 69% of cases are diagnosed while the cancer is localized to the prostate, when the five-year relative survival rate is 100%. For cancer that has spread to distant parts of the body, the five-year relative survival rate is about 40.1%.

That is why the overall survival number can be misleading if it is presented without context.

Most men diagnosed with prostate cancer do not die from it. But a diagnosis after the cancer has spread is a very different situation from finding it while it remains localized.

So when should a man consider screening?

There is no single screening schedule that applies to every man.

The American Cancer Society recommends that men have an informed conversation with a health care provider about the potential benefits, risks and uncertainties of prostate cancer screening.

Under its recommendations, that discussion should generally begin at:

• Age 50 for men at average risk who are expected to live at least another 10 years.
• Age 45 for men at higher risk, including Black men and men with a father or brother who was diagnosed with prostate cancer before age 65.
• Age 40 for men with more than one first-degree relative who developed prostate cancer at an early age.

The U.S. Preventive Services Task Force takes a somewhat different approach. Its current published recommendation says men ages 55 to 69 should make an individual decision about PSA-based screening after discussing the potential benefits and harms with a clinician. It recommends against routine PSA screening for men 70 and older. The Task Force’s prostate-screening recommendation is currently being updated.

The difference between these recommendations is one reason a man should not treat an internet checklist as a substitute for a conversation with his doctor.

A PSA test does not automatically mean cancer

The most common screening tool is a blood test that measures prostate-specific antigen, or PSA.

But PSA is not a simple cancer detector.

An elevated PSA can be caused by prostate cancer, but it can also occur because of an enlarged prostate or inflammation of the prostate. A higher result can lead to additional testing and sometimes a biopsy. Screening can also detect cancers that would never have caused symptoms or threatened a man’s life, creating the possibility of unnecessary treatment and side effects.

That is why the screening decision involves a balance.

The potential benefit is finding a dangerous cancer earlier. The potential downside is undergoing tests and treatment for a cancer that might never have caused harm.

What about Latino men?

The available evidence suggests that Hispanic men should not be treated as one uniform group when it comes to prostate cancer screening.

A recent study examining Hispanic men from different backgrounds found that only 46% of Hispanic men ages 55 to 69 reported ever having a PSA test. Screening rates varied considerably by race within the Hispanic population, heritage and access to primary care. Men who had a regular primary-care provider and health insurance were more likely to have undergone PSA screening.

California’s cancer data add another reason for paying attention to these differences. The statewide study found an approximately 8% annual increase in distant-stage prostate cancer among Hispanic men from 2014 through 2021.

Those numbers do not tell us why an individual man was or was not screened. They also do not prove that changes in screening caused the rise in advanced disease.

They do show that access, screening practices, family history, age and individual risk can matter and that Latino men are not one single risk group.

What the data can tell us

The evidence shows that prostate cancer is common, U.S. diagnoses have been rising again, and California has experienced a substantial increase in distant-stage disease. It also shows that prostate cancer outcomes are far better when the cancer remains localized.

What the data cannot tell us

The statistics cannot predict what will happen to one individual man.

They cannot tell a man whether he personally needs a PSA test, whether an elevated PSA means he has cancer, or whether treatment would ultimately be necessary. They also cannot establish that lower screening caused California’s increase in distant-stage disease.

Those questions require an individualized medical conversation.

The practical takeaway

For men approaching the ages when prostate cancer screening becomes relevant, the useful question is not simply “Should I get a PSA test?”

It is:

“Based on my age, family history, race, health and other risk factors, what are the potential benefits and harms of screening for me?”

That conversation can help a man understand whether screening makes sense, what a PSA result could mean, and what would happen if the result were abnormal.

Prostate cancer is common. But the evidence suggests the more important issue is making sure men understand their individual risk and the tradeoffs of finding the disease early, before deciding what to do about screening.