Rising Metastatic Prostate Cancer Rates but Narrowing Racial Gap

Authors

• Hanna Zurl
• Zhiyu Qian
• Klara K Pohl
• Andrea Piccolini
• Stephan M Korn
• Muhieddine Labban
• Stuart R Lipsitz
• Mansoo Cho
• Sean A Fletcher
• Marianne Leitsmann
• Sascha Ahyai
• Quoc-Dien Trinh
• Alexander P Cole

Language

English

Publication Date

11-6-2025

Journal

BMC Medicine

DOI

10.1186/s12916-025-04448-6

PMID

41199310

PMCID

PMC12590629

PubMedCentral® Posted Date

11-6-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background: In recent years, there has been considerable interest in addressing racial disparities in prostate cancer (PCa) care including risk-adapted screening. This study examined trends in metastatic PCa incidence by race and placed them in context of changes in PSA screening recommendations.

Methods: We analyzed metastatic PCa incidence trends by race (using Surveillance Epidemiology and End Results data, 2005-2021) and PSA screening trends (using Behavioral Risk Factors Surveillance Survey data, 2012-2020). We fitted a generalized linear model with an interaction term for race and year of diagnosis and calculated annual incidence rate ratios (metastatic disease) and odds ratios (screening) for Non-Hispanic Black (NHB) vs. Non-Hispanic White (NHW) men.

Results: From 2005 to 2021, the age-adjusted metastatic PCa incidence (per 100,000) increased from 16.4 to 22.3 in NHB men, and from 6.2 to 10.8 in NHW men. While the incidence increased in both groups, the NHB vs. NHW incidence rate ratio declined from 2.6 (95%CI: 2.4, 2.9) in 2005 to 2.1 (95%CI:2.0,2.2) in 2021 (p < .0001), indicating a narrowing racial gap. From 2012 to 2020, PSA screening declined in both groups. NHB men initially had higher rates (OR:1.34, 95%CI: 1.21, 1.49, p < 0.0001) but experienced a steeper decline, resulting in no significant difference by 2020 (OR: 1.04, 95% CI: 0.91, 1.19, p = 0.59).

Conclusions: The racial gap in metastatic PCa narrowed over the study period, while overall incidence increased. Higher screening rates among Black men in the early 2010s may explain the narrowing gap. The subsequent more rapid decline among Black men raises concerns about resurgence of racial disparities in the coming years.

Keywords

Aged, Humans, Male, Middle Aged, Black or African American, Early Detection of Cancer, Healthcare Disparities, Incidence, Neoplasm Metastasis, Prostate-Specific Antigen, Prostatic Neoplasms, SEER Program, United States, White, Metastatic prostate cancer incidence, Racial disparities, Prostate-specific antigen, Surveillance Epidemiology and End Results Program (SEER), Behavioral Risk Factor Surveillance System (BRFSS), Health equity, Prostate cancer screening

Published Open-Access

yes

Recommended Citation

Zurl, Hanna; Qian, Zhiyu; Pohl, Klara K; et al., "Rising Metastatic Prostate Cancer Rates but Narrowing Racial Gap" (2025). Faculty, Staff and Student Publications. 4104.
https://digitalcommons.library.tmc.edu/uthmed_docs/4104