A new study from UC San Francisco (UCSF) has revealed a concerning rise in advanced prostate cancer cases across California over the past decade. Researchers link this increase to shifts in screening recommendations, which led to fewer men undergoing routine prostate cancer screenings. This trend mirrors what is happening across the country but is more pronounced in California, where cases have grown at a faster rate than the national average.
Alongside this rise, prostate cancer mortality rates—which had been declining for years—have now leveled off in most parts of the state. These findings highlight the ongoing challenge of balancing early detection with avoiding unnecessary treatments, a dilemma that continues to shape prostate cancer screening policies.
The study, published on January 27 in JAMA Network Open, emphasizes the importance of finding an effective screening strategy that detects life-threatening cancers while minimizing the diagnosis of non-aggressive tumors that may never pose a health risk.
A Statewide Concern Across All Demographics
“This overall rising trend is alarming and has occurred across age groups, regions of California, races, and ethnicities,” said Erin L. Van Blarigan, ScD, an associate professor of Epidemiology & Biostatistics and Urology at UCSF and the lead author of the study.
“Our data point to how urgent this problem is,” she added. “Figuring out the best way to screen for prostate cancer continues to be a challenge for researchers and doctors. Without screening, the number of men diagnosed with advanced prostate cancer – when treatments are less effective – increases fast.”
Balancing the Risks and Benefits of Prostate Cancer Screening
Prostate cancer is the most common cancer among men in the U.S. and the second-leading cause of cancer-related deaths. However, not all cases are the same—while some forms of the disease are aggressive and potentially fatal, many cases involve low-grade tumors that remain contained and never spread.
The most common screening method, prostate-specific antigen (PSA) testing, is widely used but comes with limitations. Since PSA tests cannot distinguish between aggressive and non-aggressive cancers, some men are diagnosed and treated for prostate cancer that would never have caused them harm. This can lead to unnecessary procedures, including surgeries that come with risks like incontinence and sexual dysfunction.
On the other hand, forgoing screenings entirely means that some aggressive cancers may go undetected until they reach advanced stages, when treatment options become less effective.
For years, doctors routinely screened all men for prostate cancer. However, in 2012, the U.S. Preventative Services Task Force (USPSTF) recommended that routine PSA testing should no longer be performed for all men to reduce unnecessary medical interventions. By 2018, guidelines were updated again, suggesting that men ages 55-69 should discuss screening options with their doctor to weigh the potential benefits and risks.
Despite these updated recommendations, not all men are having these conversations with their physicians, raising concerns that some individuals at higher risk may be missing the opportunity for early detection.
Prostate Cancer Cases and Death Rates in California
The UCSF study examined data from nearly 388,000 men diagnosed with prostate cancer in California between 2004 and 2021. Of these cases, almost 28,000 men (7.2%) had been diagnosed with advanced-stage prostate cancer, a form of the disease with a five-year survival rate of just 37%.
Researchers also looked at prostate cancer mortality trends over the same period and found that, after years of decline, death rates have stopped decreasing in many parts of California.
Key findings from the study include:
- Advanced prostate cancer rates remained stable or declined until 2010, but then began rising at a rate of 6.7% per year from 2011 to 2021.
- Nationally, cases rose by 4.5% per year between 2011 and 2019, making California’s increase significantly higher than the U.S. average.
- Some regions in California saw faster increases than others—the lowest annual growth was in the Southern San Joaquin Valley (2.3%), while the highest increase was in the Central Coast (9.1%).
- Prostate cancer deaths declined by 2.6% per year from 2004 to 2012 but then plateaued in 7 out of 10 regions in the state.
- Mortality rates were highest in the Inland Empire, followed by San Diego-Imperial and the North Coast, while the lowest mortality rates were found in the San Francisco Bay Area.
These findings suggest that regional differences in healthcare access, screening awareness, and lifestyle factors may influence cancer detection and outcomes.
The Importance of Ongoing Monitoring and Research
As scientists continue to examine prostate cancer trends, keeping a close eye on how screening guidelines affect different populations is critical.
“It’s important to continue monitoring prostate cancer trends both in California and nationally as we learn more about the impact of screening guidelines on different populations,” said Scarlett L. Gomez, PhD, MPH, a senior author of the study and a professor in the UCSF Department of Epidemiology & Biostatistics.
Going forward, researchers and healthcare providers will need to find a balance between early detection and reducing unnecessary treatments. Emerging advancements in genetic testing, biomarker analysis, and imaging technologies may help doctors better identify high-risk patients who would benefit most from screening while avoiding overdiagnosis in low-risk individuals.
Looking Ahead: What This Means for Men’s Health
Prostate cancer remains a major health concern, and the findings from this study highlight the need for continued awareness, research, and patient education. While the debate over screening guidelines continues, one thing is clear—early detection remains key for those at high risk.
Men should have open discussions with their doctors about the benefits and risks of screening, particularly if they have a family history of prostate cancer or belong to high-risk groups.
As research progresses, medical professionals hope to develop better screening methods that can distinguish between aggressive and non-aggressive cancers, ensuring that those who need treatment receive it while others avoid unnecessary medical interventions.
The study was published in JAMA Network Open under the title “Trends in Prostate Cancer Incidence and Mortality Rates” and funded by the California Department of Public Health, Centers for Disease Control and Prevention’s National Program of Cancer Registries, and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program.
