ATLANTA — In a revealing new report released by the American Cancer Society (ACS), alarming trends have emerged in the landscape of prostate cancer in the United States. After years of steady decline, prostate cancer incidence rates have notably reversed trajectory, rising at approximately 3.0% annually between 2014 and 2021. Particularly concerning is the most pronounced surge in late-stage, or advanced prostate cancer cases, which showed an annual increase of 4.6% to 4.8%. This escalation contrasts sharply against the backdrop of a slowing decline in prostate cancer mortality, which over the past decade has plateaued to roughly 0.6% per year, a stark deceleration compared to the sharper decreases of 3% to 4% per annum observed in the closing decades of the 20th century.
This epidemiological shift signals a critical inflection point in prostate cancer dynamics and raises profound questions about underlying biological, social, and healthcare factors influencing these patterns. Notably, distant-stage prostate cancer—the disease’s most aggressive and lethal form—has steadily increased across all age demographics. Men under 55 have experienced an almost 3% rise per year, while those 55 and older have seen increases closer to 6% annually. This trend portends grim prognostic implications, as the five-year relative survival rate for distant-stage diagnoses lingers at a daunting 38%, a stark contrast to near complete survival rates for localized disease detected earlier.
The report further illuminates disturbing racial and ethnic disparities that persist despite advances in detection and treatment. Black men echo a disproportionately heavy burden, with mortality rates double those observed in White men, far exceeding the 67% higher incidence rates in the former group. Among Native American men, a particularly paradoxical pattern is observed: they experience a 12% higher mortality than White men even though their incidence rates are about 13% lower. American Indian and Alaska Native men also exhibit the highest rates of distant-stage prostate cancer diagnoses, underscoring systemic inequities and highlighting areas in urgent need of tailored intervention and research.
Geographically, prostate cancer mortality exhibits striking variation across the United States. The fatality rates peak notably in regions with substantial Black populations, such as Washington D.C. and Mississippi, where deaths per 100,000 men reach 27.5 and 24.8, respectively. These patterns emphasize how demographic concentration and access to quality care intertwine to shape cancer outcomes on a statewide scale. The data thus advocate for place-based strategies combining community engagement, enhanced screening, and healthcare equity to curtail mortality.
From a technical perspective, these findings arrive at a complex juncture in prostate cancer biology and clinical epidemiology. The increasing incidence of late-stage cancers despite widespread screening availability suggests potential shifts in tumor biology, delays in diagnosis, or modifications in screening practices that might miss or underdetect aggressive variants. Moreover, the slowed decline in mortality may reflect plateauing efficacy of existing treatments or late detection limiting potential therapeutic success. It also raises questions about the role of emerging molecular markers, genetic predispositions, and environmental factors that may be differentially impacting subpopulations.
The lead author of the study, Tyler Kratzer, MPH, emphasizes the need for nuanced strategies in early detection, particularly for high-risk groups. He advocates for clinicians to start screening discussions with all men by age 50, but recommends advancing this dialogue to age 45 for Black men and men with family histories of prostate cancer. This tailored approach acknowledges both biologic risk and social determinants influencing outcomes, striving to optimize the benefit-to-harm ratio of prostate-specific antigen (PSA) testing and minimize overdiagnosis.
At a public health and policy level, these data invigorate support for legislative efforts like the Prostate-Specific Antigen Screening for High-risk Insured Men (PSA Screening for HIM) Act. This pending federal legislation aims to eliminate financial barriers to screening for men at elevated risk by waiving deductibles, copays, and coinsurance. Barriers such as out-of-pocket costs have been identified as critical impediments to accessing preventive services, particularly in vulnerable populations, potentially exacerbating disparities in early detection and survival.
The report’s senior author, Rebecca Siegel, MPH, reiterates the moral imperative behind addressing these disparities. By ensuring equal access to early diagnosis and treatment advances, public health efforts can work to balance the scales of cancer survival. The ACS’s focus on tailoring research and resources to communities disproportionately affected by prostate cancer aligns with growing recognition that equity must be central to cancer control.
Prostate cancer remains the most frequently diagnosed cancer among men in the U.S., accounting for roughly 30% of all male cancer cases in 2025. Its status as the second leading cause of cancer death in men—behind only lung cancer—highlights the continued lethality of this disease despite technological and therapeutic advances. Current ACS estimates project approximately 313,780 new cases and 35,770 deaths in this year alone, underscoring the magnitude of the challenge.
Central to interpreting the report is understanding the epidemiologic data sources, which comprise population-based cancer registries managed by the National Cancer Institute and detailed mortality data collated by the Centers for Disease Control and Prevention. This comprehensive dataset, extending incidence through 2021 and mortality through 2023, provides robust statistical power to discern temporal trends and subgroup analyses, bolstering confidence in the conclusions drawn.
Scientists and clinicians invested in this research include an interdisciplinary team with expertise spanning cancer epidemiology, surveillance research, and clinical oncology. Alongside Kratzer and Siegel, contributors such as Natalia Mazzitelli, MPH, Jessica Star, MPH, Dr. William Dahut, and Dr. Ahmedin Jemal have brought diverse perspectives and analytical rigor to elucidate the evolving prostate cancer landscape.
In sum, this ACS report serves as a clarion call for intensified research into the etiological factors driving late-stage prostate cancer increases, enhanced targeted screening initiatives, and resolute commitment to addressing systemic inequities. It encapsulates a pivotal moment in cancer epidemiology where past gains are under threat from emerging challenges, challenging the medical community to innovate and advocate with renewed vigor.
Subject of Research: Prostate cancer incidence, mortality trends, and disparities in the United States
Article Title: New ACS Prostate Cancer Statistics Report Reveals Rising Late-Stage Incidence and Slowing Mortality Declines
News Publication Date: September 2, 2025
Web References:
- https://www.cancer.org
- https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.70028
- https://www.fightcancer.org/sites/default/files/psa_4_him_factsheet_final_2.21.25.pdf
Image Credits: American Cancer Society
Keywords: Prostate cancer, cancer incidence, mortality trends, racial disparities, cancer epidemiology, PSA screening, late-stage cancer
