Investigators may have uncovered concerning trends in prostate cancer outcomes across California in a new study, revealing distant-stage disease increased significantly while previously declining mortality rates have stalled.
In the study, published in JAMA Network Open, the investigators analyzed 387,636 prostate cancer cases diagnosed between 2004 and 2021 in California, including 27,938 distant-stage cases and 58,754 deaths. They found that the incidence of distant-stage prostate cancer increased by 6.7% annually between 2011 and 2021, while mortality rates, which had been declining by 2.6% annually between 2004 and 2012, plateaued from 2012 to 2021.
"Implementation of more effective prostate cancer screening strategies are critically needed," wrote lead study author Erin L. Van Blarigan, ScD, and colleagues from the University of California, San Francisco.
The increases in distant-stage disease were widespread across demographic groups and regions by approximately 6% or more annually in nine of California's 10 regions. Hispanic male patients experienced the steepest rise at 8.0% annually between 2014 and 2021, followed by non-Hispanic Black male patients at 7.4% between 2013 and 2021.
The investigators also noted that racial disparities remained severe. Non-Hispanic Black male patients demonstrated both the highest incidence of distant-stage disease and more than double the mortality rate compared with any other racial/ethnic group throughout the study period.
The investigators linked these trends to changes in prostate-specific antigen (PSA) screening guidelines. In 2012, the U.S. Preventive Services Task Force recommended against routine PSA screening for all men. However, while guidelines were updated in 2018 to support individualized screening decisions for men aged 55 to 69 years, separate studies have found no evidence that this revision has impacted outcomes.
Further, regional variations emerged. Although the Inland Empire did not have the highest distant-stage disease incidence, patients residing in the area had the highest mortality rates. This finding suggested potential disparities in access to guideline-based treatments for advanced disease.
The investigators noted particular concern about implications for health equity. "There is concern these guidelines will exacerbate existing prostate cancer disparities for underserved populations with less access to health care as well as minoritized populations who may be less likely to engage in such discussions due to medical mistrust," the study authors emphasized.
The study represented the most current and comprehensive analysis of California prostate cancer trends. The investigators expressed concern regarding the urgent public health implications of the findings, particularly those surrounding screening strategies and access to care for advanced disease.
Full disclosures can be found in the study.
