THE RISE in distant-stage prostate cancer cases in the United States has raised concerns, particularly following changes in PSA screening guidelines. Prostate cancer remains the most diagnosed cancer and the second-leading cause of cancer-related deaths among men in the country. While some prostate cancers are highly aggressive, others remain indolent and never metastasise. The inability of PSA screening to differentiate between these has led to fluctuating screening guidelines over the past two decades, impacting diagnosis and treatment outcomes.
In 2008, the US Preventative Services Task Force (USPSTF) recommended against PSA screening for men over 75, extending this to all men in 2012. However, with increasing concerns over late-stage diagnoses, guidelines were revised in 2018, advising men aged 55–69 to discuss screening with their healthcare provider. Despite this, there is uncertainty about how well-shared decision-making is being implemented and whether at-risk populations, such as non-Hispanic Black men, are being effectively screened.
Recent data highlight a concerning rise in distant-stage prostate cancer cases. Between 2011–2019, the American Cancer Society reported an annual increase of 4.5%, with non-Hispanic Black men experiencing a 5% annual rise. A study using SEER data found similar trends across racial and ethnic groups, with incidence rates increasing by 4-6% per year. In California, where the highest number of prostate cancer cases and deaths are expected in 2023, distant-stage prostate cancer incidence increased by an average of 6.7% annually from 2011–2021. The rise exceeded 6% in nine out of ten regions, with the Central Coast experiencing a 9% yearly increase.
These findings suggest that the reduction in PSA screening has had a widespread impact, with the 2018 guideline changes yet to show any improvement. Without targeted interventions, existing disparities may worsen, particularly for underserved populations with limited healthcare access. Continued monitoring and policy adjustments will be crucial to addressing the rising incidence of late-stage prostate cancer and ensuring equitable healthcare access for all populations.
Katie Wright, EMJ
Reference
Van Blarigan EL et al. Trends in prostate cancer incidence and mortality rates. JAMA Netw Open. 2025;8(1):e2456825.
