Study points to increasing incidence of advanced prostate cancer in California

A team of investigators from the University of California, Los Angeles (UCLA) have found that the incidence of distant stage prostate cancer has been markedly increasing throughout California from 2011 to 2021.¹

"Without screening, the number of men diagnosed with advanced prostate cancer—when treatments are less effective—increases fast," says Erin L. Van Blarigan.

The data, published in JAMA Network Open, also showed that mortality plateaued during this period despite declining in previous years.

“Our data point to how urgent this problem is,” said lead author Erin L. Van Blarigan, ScD, an associate professor of urology and epidemiology & biostatistics at UCLA, in a news release on the findings.² “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.”

For the study, the investigators assessed incidence data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program and the US Census. Mortality data was collected from the California Cancer Registry and California Department of Public Health's Center for Health Statistics.

In total, there were 387,636 prostate cancer cases in California between 2004 and 2021, of which 27,938 cases were distant stage disease at diagnosis. There were also 58,754 deaths attributed to prostate cancer during that period.

Incidence data showed stable rates of new cases from 2004 to 2010, following by an average decrease of 9.7% from 2010 to 2014. Following that, the incidence of prostate cancer increased by 2.6% (95% CI, 1.1%-4.5%) per year from 2014 to 2021.

Starting around 2014, the rise in overall incidence reached statistical significance among non-Hispanic Black men (APC, 4.6%; 95% CI, 2.5% to 7.2%), Asian American, Native Hawaiian, and Pacific Islander men (APC, 3.7%; 95% CI, 2.4% to 5.3%), and non-Hispanic White men (APC, 3.1%; 95% CI, 1.4% to 5.3%). From 2018 to 2021, the incidence rate was markedly higher in the Central Coast region compared with the other 9 regions assessed.

According to the authors, the rise in overall incidence “was driven by changes in regional and distant stage disease; there was no increase in the incidence of localized prostate cancer during the study period.”

Specifically, the incidence of distant stage disease increased by 6.7% (95% CI, 6.2%-7.3%) per year from 2011 to 2021, following a period of decline from 2004 to 2011. The highest incidence rates were seen in non-Hispanic Black men.

By region, the annual percentage change (APC) in distant stage prostate cancer was greater than 6% across 9 of 10 California regions assessed. After 2010, the incidence of distant-stage disease increased in all 10 California regions assessed. The lowest increase was observed from 2002 to 2021 in Southern San Joaquin Valley (2.3% per year), and the highest increased was observed from 2013 to 2021 in Central Coast (9.1% per year).

Mortality data showed that prostate cancer death rates declined by approximately 2.6% per year from 2004 to 2012 but plateaued from 2012 to 2021. This trend was seen across all ages, races, ethnicities, and regions assessed.

The authors noted, “Non-Hispanic Black males had the highest prostate cancer mortality rate between 2004 and 2021 in California, which is more than twice the mortality observed in any other racial or ethnic group.”

When assessing these trends by age, mortality declined among men aged 55 to 69 from 2012 to 2021 but plateaued among those aged 70 years or older from 2012 to 2021.

Based on these data, senior author Scarlett L. Gomez, PhD, MPH, concluded “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.”

References

1. Blarigan ELV, McKinley MA, Washington III SL, et al. Trends in prostate cancer incidence and mortality rates. JAMA Netw Open. 2025;8(1):e2456825. doi:10.1001/jamanetworkopen.2024.56825

2. Alarming rise in rates of advanced prostate cancer in California. News release. University of California, San Francisco. February 3, 2025. Accessed February 4, 2025. https://www.eurekalert.org/news-releases/1072383