Prostate cancer statistics, 2025

Evidence Supports a Faster Growth Rate and/or Earlier Transformation to Clinically Significant Prostate Cancer in Black Than in White American Men, and Influences Racial Progression and Mortality Disparity

Malignant transformation of the prostate and progression of carcinoma appear to be the consequence of a complex series of initiation and promotional events under genetic and environmental influences. Increased incidence of the condition may be the result of improved detection, greater awareness of the condition, and possibly an increased life expectancy accompanied by a decrease in competing causes of death rather than a true increase in the prevalence of the disease. The marked racial and geographic differences are probably multifactorial, with genetic, environmental, and possibly social influences affecting progression of the disease. Among several risk factors, evidence for the familial inheritance of some prostate cancers is compelling. Dietary influences, hormonal milieu, and the role of environmental carcinogens are currently under intense investigation. As further risk factors are identified, it will become increasingly important to identify individuals at increased risk for the disease. These men should undergo regular evaluation with state-of-the-art methods.

To learn more about local prostate cancer (PCa) disparities, we conducted descriptive analyses of the role of race and age in PCa using the Pennsylvania Cancer Registry data for Philadelphia (2005-2014). We focused on the most prevalent race/ethnic groups: white (33%), black (44%), and Hispanic (9%). Outcomes included PCa rates, tumor stage, and tumor grade. Percent change was used to describe changes in age-adjusted incidence and mortality rates. Frequency tables and logistic regression models were used to describe trends in proportions of advanced PCa by race and time. Race-by-time interaction terms were retained in the models if statistically significant. PCa incidence was highest for black men over time. Incidence rates declined over time for all race groups (- 28% for white men to - 38% for Hispanic men). PCa mortality rates declined in a less universal manner (- 5% for blacks to - 32% for whites). Each year, odds increased across all race groups for advanced tumor stage (4% each year among white and Hispanic men and 9% each year among black men) and for advanced tumor grade (4% each year among white and black men and 23% each year among Hispanic men). Among younger men, black men experienced significantly increased odds of advanced tumor stage each year (8%) and Hispanics experienced significantly increased odds of advanced tumor grade each year (30%). Black men remain at highest PCa risk relative to other racial/ethnic groups in Philadelphia. Younger black and Hispanic men are at particular risk for advanced PCa at diagnosis.

Background: In 2023, 34,000 US men will die from prostate cancer. The impact of prostate cancer mortality varies greatly across states. Racial differences in state populations may explain some but not all of this variability. This study examined prostate cancer mortality rates by state and race and their associations with state-level prostate-specific antigen (PSA) screening prevalence. Methods: We obtained race-specific, state level five-year average age-standardized prostate cancer mortality rates from 2016-2020 from the NCI State Cancer Profiles. Data on race-specific, state level PSA screening prevalence in 2010 were obtained from the Behavioral Risk Factor Surveillance System. We compared mortality rate ratios (RR, 95% confidence intervals [CI]) of state level prostate cancer mortality rates of Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaskan Native men to White men. We generated descriptive statistics (median and range) on state level mortality rates to quantify the variability within racial/ethnic groups. We fit univariable Poisson regression models to explore associations between prostate cancer mortality rates and PSA screening prevalence, for White, Black, and Hispanic men, but omitted Asian and American Indian men due to sparse data. Results: Mortality data were available for 50 states and the District of Columbia (D.C.) for White, 40 states and D.C. for Black, 36 states for Hispanic, 24 states for Asian, and 11 states for American Indian men. The US average prostate cancer mortality rate was 18.8 deaths per 100,000 per year. As expected, rates were higher among Black than White men (RR 2.07; 1.90, 2.24), while rates among Hispanic (RR 0.75; 0.68, 0.84) and Asian (RR 0.48; 0.41, 0.56) men were lower. Rates among American Indian men were slightly higher than White men (RR 1.12; 0.96, 1.29). Variability of state-level mortality rates within each race was quite high, with largest ranges for Black and American Indian men. Black men had a median (range) state-level prostate cancer mortality rate of 37.9 (23.9 to 49.2), and American Indian men had a median rate of 20.4 (7.7 to 28.9). Median (range) rates were 17.7 (11.3 to 22.3) for White, 8.3 (4.3 to 17.4) for Asian, and 13.5 (8.9 to 22.5) for Hispanic men. Associations between a 5-percentage point increase in PSA screening prevalence and prostate cancer mortality rates were RR 0.92 (95% CI: 0.84, 0.99) in White, RR 0.96 (0.88, 1.05) in Black, and 0.98 (0.90, 1.07) in Hispanic men. Conclusion: There is considerable variability in prostate cancer mortality rates across states, both between and within racial/ethnic groups, highlighting complexity of racial disparities. PSA screening may weakly contribute to this variability, but other factors such as health care access, social determinants, and lifestyle factors that vary between states should be considered in future studies. Citation Format: Hannah E. Guard, Jane B. Vaselkiv, Ethan Ecsedy, Florian Kuechen, Nareg Minassian, James Dun Rappaport, Zhiyu Qian, Michelle O. Sodipo, Kathryn L. Penney, Konrad H. Stopsack, Lorelei A. Mucci. Examining state- and race-specific five-year prostate cancer mortality rates (2016-2020) and their association with prostate-specific antigen screening [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4858.

Introduction: Black men have 2.1 times higher prostate cancer mortality rates than White men in the United States, yet the reasons for this disparity remain unclear. Several dietary and lifestyle factors may influence the risk of developing lethal prostate cancer. This study evaluated to what extent differences in the prevalence of modifiable risk factors by race could explain racial disparities in prostate cancer mortality. Methods: Our study utilized data from the Health Professionals Follow-up Study (HPFS, N=51,529 men, 1986-2016) and the National Health and Nutrition Examination Study (NHANES, 2000-2010). First, we used data from NHANES to estimate the prevalence of three factors among Black and White men: smoking, vitamin D, and coffee. Then, using HPFS, we generated relative risk estimates for lethal prostate cancer for each factor. To estimate the relative prostate cancer burden associated with these risk factors, we calculated the population attributable fraction (PAF) for each factor by self-identified race, defined as the reduction in mortality that would be achieved if the population had been entirely unexposed, compared with the current exposure pattern. We then calculated the difference in the PAF between Black and white men to estimate the difference in mortality reduction between the two groups if all men had been entirely unexposed, assuming causality of risk factors and no effect modification by race. Results: There were notable differences in the prevalence of several risk factors by race. For example, Black men had significantly lower levels of vitamin D[MLA1], were less likely to drink coffee, and had a higher prevalence of smoking compared to white men. We estimated that eliminating these risk factors among Black men could lead to a reduction in prostate cancer mortality that is 4-14% larger compared to eliminating these risk factors among white men. Conclusions: Modifiable lifestyle and dietary factors are potentially responsible for a proportion of the racial disparity in prostate cancer mortality. Our future work will expand the modifiable factors as well as incorporating more contemporary comparisons of the prevalence of these factors to predict future disparities in prostate cancer. Citation Format: Emily Rencsok, Michelle Sodipo, Travis Gerke, Konrad Stopsack, Lorelei Mucci. Racial disparities in prostate cancer mortality rates explained by differences in dietary and lifestyle factors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 38.

Background: Black men in the US demonstrate a two-fold increase in prostate cancer mortality compared to men of other races/ethnicities. The aim of this analysis was to understand how access to high quality care—estimated using surgical volume— impacts disparities in prostate cancer mortality between Black and White men with localized prostate cancer. Methods: This is an analysis of a SEER-Medicare cohort of men diagnosed with localized prostate cancer (cT1-4N0M0) managed primarily by radical prostatectomy from 2005-2015. This analysis was restricted to Black and White men due to low representative numbers of men of other races/ethnicities. Social, demographic, and clinical data were obtained. Both facility and provider data were obtained using administrative data in Medicare. Surgical volume for both providers and facilities were stratified into low, medium, and high. Simple descriptive analyses were performed. Multivariable Cox regression analyses was used to assess the relationship between race, surgical volume, and various clinical and social variables. Results: Black men represented 2,070 (7.1%) of the 29,071 men in this cohort. Black men in the cohort had a higher proportion of prostate specific antigen (PSA) greater than 20 ng/mL (7.0% vs 3.6%) and a higher proportion of men with cT1 disease at diagnosis (64.6% vs 56.1%) when compared to White men. Black men were also less likely to be married/partnered (63.5% vs. 79.9%), more likely to reside in an impoverished zip code (43.9% vs. 11.1%), and more likely to have significant comorbidities (7.2% vs. 2.9%). Black men in this cohort were most likely to be treated in the Southern US (42.8% of cases). Black men were more likely to be treated at a minority serving hospital/facility (24.6% vs. 3.1%, p < 0.001), more likely to be treated at a very large hospital/health system (p < 0.001), and less likely to be treated by a high-volume surgeon or facility (7.7% vs. 19.9%, p < 0.001) compared to White men. On multivariable analysis adjusted for race, hospital type, NCI comorbidity index, clinical stage, and prostatectomy volume; black men demonstrated an increased risk of prostate cancer mortality (hazard ratio 1.27, 95% CI 0.94, 1.72) compared to White men. On stratified analysis, there were no racial disparities in cancer-specific mortality among men treated by a high-volume provider/facility. In contrast, Black men treated by a low/medium volume provider/facility had a higher likelihood of prostate cancer related death following surgery (hazard ratio 1.41, 95% CI 1.02, 1.95, p = 0.04). Conclusions: Black Medicare beneficiaries with prostate cancer demonstrate unique patterns of surgical care utilization, with differences noted in the types and surgical volumes—and likely surgical quality—of their health facilities and providers. Our findings suggest that access to high-quality prostate cancer care is an important mediator of racial disparities in prostate cancer, even among men with access to health insurance. Citation Format: Yaw A. Nyame, Sarah K. Holt, Ruth Etzioni, John L. Gore. Racial disparities in the quality of surgical care among Medicare beneficiaries with prostate cancer [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-211.

Purpose: To assess the role of genetic and epidemiological risk factors in explaining racial disparities in prostate cancer incidence and mortality. Background: Black men are 1.6 times more likely to be diagnosed and 2.4 times more likely to die of prostate cancer than white men. An adequate explanation for these disparities remains elusive, as they have been shown to persist in equal care and equal access settings. Our group has previously shown associations between exposures of smoking, physical activity, body mass index (BMI) vitamin D level, coffee, lycopene, and genetic factors and risk of prostate cancer, particularly for lethal disease. We hypothesized that differences in the prevalence of these risk factors could explain a substantial proportion of the racial disparity in incident and lethal prostate cancer. Study Population: Our study utilized data on risk factor prevalence from the Health-Professionals Follow-Up Study (HPFS, N=51,529 men, 1986-2012) and the National Health and Nutrition Examination Study (NHANES III, 1988-1994), a nationally representative program of studies that gathers lifestyle and nutrition information. We used established relative risk estimates from the HPFS for the prostate cancer risk factors. Methods: To estimate the prostate cancer burden associated with these exposures, we calculated the population attributable fraction (PAF) for each risk factor by race. PAF can be defined as the reduction in incidence that would be achieved if the population had been entirely unexposed, compared with the current exposure pattern. We assumed that the risk ratio was the same among whites and blacks. To calculate the PAF, we used the prevalence of the exposure (risk factor) from the HPFS and NHANES III and crude and confounder-adjusted risk ratios from studies conducted in the HPFS cohort for each exposure and risk of lethal prostate cancer. We then calculated the difference in attributable risk between each race to estimate the reduction in lethal prostate cancer if black men had the same prevalence of risk factors as white men. Results: There were notable differences in risk factor prevalence by race. For example, black men had significantly lower levels of vitamin D, were less likely to drink coffee, and had a higher prevalence of obesity and smoking. The prevalence of several genetic loci for prostate cancer were also higher among black men. We estimated that if black men had the same prevalence of risk factors as white men, the percent reduction in prostate mortality was 18% for Vitamin D, 7% for obesity, 6% for genetic factors, 4% for coffee, 4% for current smoking, and 1% for lycopene. Conclusions: Certain lifestyle, dietary, and genetic factors are potentially responsible for a substantial proportion of the racial disparity in prostate cancer incidence and mortality. This important finding warrants further research and validation in additional cohorts, as our findings go beyond merely re-confirming that a racial disparity in prostate cancer persists: it suggests a strong underlying role for risk factors that could be addressed through prevention. The authors accept sole responsibility for all statements made in this abstract. Citation Format: Sam F. Peisch, Travis Gerke, Kathryn M. Wilson, Edward L. Giovannucci, Lisa B. Signorello, Lorelei A. Mucci. Racial disparities in prostate cancer: Estimating the role of diet, lifestyle, and genetic factors among African-American and Caucasian-American men. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A29.

MP17-18 PROSTATE CANCER GENETIC ALTERATIONS IN HISPANIC MEN

Trends in prostate cancer mortality among black men and white men in the United States: Chu KC, Tarone RE, Freeman HP, Center to Reduce Cancer Health Disparities, National Cancer Institute, Bethesda, MD. Cancer 2003;97:1507–1516

PD57-05 A RACE-STRATIFIED ANALYSIS OF THE ACCURACY OF PROSTATE MRI IN BIOPSY NAIVE MEN

Association Between an Eestrogen Receptor Alpha Gene Polymorphism and the Risk of Prostate Cancer in Black Men

Background: Men of African ancestry (moAA) experience the highest incidence and mortality rates of prostate Cancer (PCa) in the United States, where 1 in 8 men are expected to be diagnosed with the disease in their lifetime. Yet, most biomarkers used in PCa screening today, which are based on prostate specific antigen (PSA), are developed and validated in predominantly White populations with weak or nonexistent validation in moAA, making moAA more likely to be subjected to unnecessary prostate biopsies. To reduce this disparity in PCa detection and management, there is a critical need for new biomarkers that target the unique genetic make-up of moAA. We recently showed that plasmacytoma variant translocation 1 (PVT1), exons 4A, 4B, and 9 are overexpressed in the prostate tissues and detected in higher copy numbers in serum of moAA with PCa. In this study, we investigated the predictive power of these potential biomarkers in detecting PCa across different racial populations. Methodology: Forty serum samples from White, Hispanic, and Black men, 50 percent of whom had PCa, were analyzed to obtain copy numbers for PVT1 exons 4A, 4B, and 9. Seven logistic regression models were developed to predict PCa using single biomarkers, all pairwise combinations of biomarkers and all three biomarkers. The median area under the receiver operator characteristic curve (AUC) was used to measure the predictive accuracy of each model after a repeated, stratified k-fold cross validation. Model accuracy was first evaluated using data from all races and then for just the Black or Hispanic subpopulation. Our best performing models were compared with PSA as a predictor of PCa. We also evaluated the predictive accuracy of composite models that combined our biomarkers with PSA. Results: In predicting PCa for all races, our model with only PVT1 exon 9 achieved the highest median AUC of 0.71, which was better than the AUC of 0.63 obtained with just PSA. When PSA and PVT1 exon 9 were combined, the median AUC increased to 0.75. Combining all three biomarkers with PSA increased the median AUC to 0.813. For the Black or Hispanic subpopulation, PVT1 exon 9 achieved the highest AUC of 0.92 which was significantly higher than the median AUC of 0.63 achieved with PSA. No significant change in AUC was observed when the PVT1 biomarkers were combined with PSA. Conclusion: Our results show that PVT1 exon 9 is more accurate than PSA in predicting PCa, achieving near perfect accuracy within the Black or Hispanic subpopulation. Whereas combining PSA with PVT1 biomarkers improved the performance of PSA for all races, no significant improvement in PSA’s performance was observed in Black or Hispanic subpopulation. Thus, PVT1 exon 9 may hold the key to reducing disparity in PCa detection among moAA while improving the predictive accuracy of PSA for the general population. Citation Format: Emmanuel Owusu Asante-Asamani, Sobana Handi D. De Silva, Gargi Pal, Micheal Liss, Robin J. Leach, Olorunseun O. Ogunwobi. Serum PVT1 exon 9 copy number is a better predictor of positive prostate biopsy in Black and Hispanic men than serum prostate specific antigen. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4172.

Background Men of African ancestry (moAA) experience the highest incidence and mortality rates of prostate Cancer (PCa) in the United States, where 1 in 8 men are expected to be diagnosed with the disease in their lifetime. Yet, most biomarkers used in PCa screening today, which are based on prostate specific antigen (PSA), are developed and validated in predominantly White populations with weak or nonexistent validation in moAA, making moAA more likely to be subjected to unnecessary prostate biopsies. To reduce this disparity in PCa detection and management, there is a critical need for new biomarkers that target the unique genetic make-up of moAA. We recently showed that plasmacytoma variant translocation 1 (PVT1), exons 4A, 4B, and 9 are overexpressed in the prostate tissues and detected in higher copy numbers in serum of moAA with PCa. In this study, we investigated the predictive power of these potential biomarkers in detecting PCa across different racial populations. Methodology Forty serum samples from White, Hispanic, and Black men, 50 percent of whom had PCa, were analyzed to obtain copy numbers for PVT1 exons 4A, 4B, and 9. Seven logistic regression models were developed to predict PCa using single biomarkers, all pairwise combinations of biomarkers and all three biomarkers. The median area under the receiver operator characteristic curve (AUC) was used to measure the predictive accuracy of each model after a repeated, stratified k-fold cross validation. Model accuracy was first evaluated using data from all races and then for just the Black and Hispanic subpopulation. Our best performing models were compared with PSA as a predictor of PCa. We also evaluated the predictive accuracy of composite models that combined our biomarkers with PSA. Results In predicting PCa for all races, our model with only PVT1 exon 9 achieved the highest median AUC of 0.71, which was better than the AUC of 0.63 obtained with just PSA. When PSA and PVT1 exon 9 were combined, the median AUC increased to 0.75. Combining all three biomarkers with PSA increased the median AUC to 0.813. For the Black and Hispanic subpopulation, PVT1 exon 9 achieved the highest AUC of 0.92 which was significantly higher than the median AUC of 0.63 achieved with PSA. No significant change in AUC was observed when the PVT1 biomarkers were combined with PSA. Conclusion Our results show that PVT1 exon 9 is more accurate than PSA in predicting PCa, achieving near perfect accuracy within the Black and Hispanic subpopulation. Whereas combining PSA with PVT1 biomarkers improved the performance of PSA for all races, no significant improvement in PSA’s performance was observed in Black and Hispanic subpopulations. Thus, PVT1 exon 9 may hold the key to reducing disparity in PCa detection among moAA while improving the predictive accuracy of PSA for the general population Citation Format: Emmanuel Owusu Asante-Asamani, Dinuka Sewandi De Silva, Gargi Pal, Michael Liss, Robin Leach, Olorunseun Ogunwobi. Prediction of positive prostate biopsy is significantly improved in Black and Hispanic men when serum PVT1 exon 9 copy number is combined with serum prostate specific antigen [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr A064.

Background Men of African ancestry (moAA) experience the highest incidence and mortality rates of prostate Cancer (PCa) in the United States, where 1 in 8 men are expected to be diagnosed with the disease in their lifetime. Yet, most biomarkers used in PCa screening today, which are based on prostate specific antigen (PSA), are developed and validated in predominantly White populations with weak or nonexistent validation in moAA, making moAA more likely to be subjected to unnecessary prostate biopsies. To reduce this disparity in PCa detection and management, there is a critical need for new biomarkers with demonstrated usefulness in moAA. We recently showed that plasmacytoma variant translocation 1 (PVT1), exons 4A, 4B, and 9 are overexpressed in the prostate tissues and detected in higher copy numbers in serum of moAA with PCa. In this study, we investigated the predictive power of these potential biomarkers in detecting high-grade PCa across different racial populations. Methodology Forty serum samples from White, Hispanic, and Black men, 50% of whom had PCa with 25% showing high-grade PCa, were analyzed to obtain copy numbers for PVT1 exons 4A, 4B, and 9. Seven logistic regression models were developed to predict PCa using individual PTV1 biomarkers, all pairwise combinations of biomarkers and all three biomarkers. The median area under the receiver operator characteristic curve (AUC) was used to measure the predictive accuracy of each model after a repeated, stratified k-fold cross validation. Model accuracy was first evaluated using data from all races and then for just the Black and Hispanic subpopulation. Our best performing models were compared with PSA as a predictor of PCa. We also evaluated the predictive accuracy of composite models that combined our biomarkers with PSA. Results In predicting high-grade PCa for all races, PSA had a median AUC of 0.58. All our PVT1 biomarkers had an AUC greater than 0.64, which was better than PSA. When PSA and PVT1 exon 4B were combined, the median AUC of PSA increased to 0.67, other PTV1 biomarkers did not improve the AUC of PSA. For the Black and Hispanic subpopulation, PVT1 exon 4A achieved the highest median AUC of 0.92 which was significantly higher than the median AUC of 0.33 achieved with PSA. The model with Exon 4A and Exon 4B as well as all three biomarkers achieved perfect discrimination (AUC of 1.0). We were also able to obtain perfect discrimination when PVT1 exon 4A was combined with PSA (AUC: 1.0). Conclusion Our results show that PVT1 exon 4A is more accurate than PSA in predicting high-grade PCa in Black and Hispanic subpopulations, achieving perfect discrimination when combined with PSA. Significant improvement in PSA’s predictability is observed in all races when combined with PTV1 exon 4B. Thus, PVT1 exon 4A and PVT1 exon 4B may hold the key to reducing disparity in high-grade PCa detection among moAA while improving the predictive accuracy of PSA for the general population. Citation Format: Emmanuel Owusu Asante-Asamani, Dinuka S.H. Sewandi De Silva, Gargi Pal, Michael Liss, Robin Leach, Olorunseun O. Ogunwobi. Serum PVT1 exons 4A and 4B copy numbers are better predictors of high-grade prostate cancer in Black and Hispanic men than serum prostate specific antigen [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr A065.

DISEASE RECURRENCE IN BLACK AND WHITE MEN UNDERGOING RADICAL PROSTATECTOMY FOR CLINICAL STAGE T1-T2 PROSTATE CANCER