A comprehensive new study conducted by researchers at UC San Francisco (UCSF) has brought to light a troubling development in men’s health.
Over the last decade, California has witnessed a sharp increase in the number of men diagnosed with advanced prostate cancer. This surge in cases has been linked to changes in prostate cancer screening practices, which resulted in fewer men undergoing routine screenings.
Although this pattern reflects a national trend, the acceleration appears to be far more pronounced within California, where the growth in advanced prostate cancer diagnoses has surpassed the national average.
What makes these findings even more concerning is the stagnation in prostate cancer mortality rates. For many years, these death rates had been steadily declining thanks to earlier detection and improved treatment strategies.
Now, however, they have leveled off in most regions of the state. These shifts underscore the ongoing challenge faced by medical professionals—how to balance the lifesaving potential of early detection with the risk of unnecessary and potentially harmful treatments. As prostate cancer screening policies continue to evolve, this dilemma remains central to discussions among healthcare providers and researchers alike.
The results of the UCSF study, published on January 27 in JAMA Network Open, highlight the urgent need for more effective screening strategies. The authors emphasize the importance of identifying and treating life-threatening cancers while avoiding the overdiagnosis of tumors that may never pose a serious risk to a patient’s health.
A Growing Statewide Concern Affecting All Populations
The rising trend in advanced prostate cancer diagnoses isn’t confined to one particular group. According to lead author Erin L. Van Blarigan, ScD, an associate professor of Epidemiology & Biostatistics and Urology at UCSF, the increase is widespread.
“This overall rising trend is alarming and has occurred across age groups, regions of California, races, and ethnicities,” she explained. Van Blarigan’s concern is echoed throughout the research community.
She added, “Our data point to how urgent this problem is. 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.”
These sobering facts call for immediate attention and action from both healthcare professionals and public health policymakers. The clear message: the absence of regular screening could result in more men being diagnosed at later stages of the disease, when treatment options are limited and survival rates decrease significantly.
The Complex Challenge of Prostate Cancer Screening: Risks and Rewards
Prostate cancer remains the most frequently diagnosed cancer among men in the United States and stands as the second-leading cause of cancer-related deaths. Despite its prevalence, not all prostate cancers behave the same way. While some tumors are aggressive and potentially life-threatening, many are classified as low-grade and remain confined to the prostate, often posing little to no threat.
The most widely used method of screening—prostate-specific antigen (PSA) testing—has both advantages and drawbacks. While PSA tests can help detect cancer early, they lack the ability to differentiate between aggressive and non-aggressive tumors. As a result, men may undergo invasive treatments for cancers that would never have caused harm during their lifetimes. These procedures can lead to serious side effects, including urinary incontinence and sexual dysfunction.
Conversely, avoiding screenings altogether can result in aggressive cancers going unnoticed until they have reached advanced stages. At that point, treatment becomes far less effective. Historically, doctors regularly recommended PSA screening for all men.
However, in 2012, the U.S. Preventive Services Task Force (USPSTF) advised against routine PSA testing for everyone, citing the need to minimize unnecessary treatments and their potential harms.
By 2018, the USPSTF revised their guidance once more, encouraging men between the ages of 55 and 69 to engage in shared decision-making with their healthcare providers. The goal was to weigh the potential risks and benefits of screening on an individual basis. Nevertheless, many men, particularly those at higher risk, may not be having these crucial conversations with their physicians, thereby missing out on early detection opportunities.
The Numbers Speak: Prostate Cancer Incidence and Mortality Trends in California
To better understand the scope of the problem, UCSF researchers analyzed data from nearly 388,000 men diagnosed with prostate cancer in California between 2004 and 2021. Of these cases, almost 28,000 men—roughly 7.2%—had advanced-stage prostate cancer at the time of diagnosis. Alarmingly, this form of the disease is associated with a five-year survival rate of just 37%.
The study also tracked prostate cancer mortality rates over the same period. After years of steady decline, death rates have stopped decreasing in many regions of California. The data uncovered several key insights:
- Advanced prostate cancer rates were either stable or declining until 2010. From 2011 to 2021, however, they began increasing at a rate of 6.7% annually.
- On a national level, advanced cases rose by 4.5% per year between 2011 and 2019. California’s increase was significantly higher.
- Regional differences emerged across the state. The Southern San Joaquin Valley experienced the slowest growth in advanced cases, at 2.3% annually. In contrast, the Central Coast saw the highest rate of increase, at 9.1% per year.
- Prostate cancer deaths declined by 2.6% per year from 2004 to 2012, but since then, they have plateaued in 7 out of 10 regions within California.
- Mortality rates were highest in the Inland Empire region, followed by San Diego-Imperial and the North Coast. The San Francisco Bay Area reported the lowest mortality rates in the state.
These patterns suggest that regional disparities in healthcare access, public awareness, and socioeconomic factors likely play a role in prostate cancer outcomes. Access to early screening and timely treatment may be better in some areas, while others may suffer from limited healthcare resources and outreach efforts.
The Critical Role of Ongoing Surveillance and Research
As the landscape of prostate cancer continues to evolve, researchers stress the need for continuous monitoring. Scarlett L. Gomez, PhD, MPH, a senior author of the UCSF study and professor in the Department of Epidemiology & Biostatistics, emphasized this point.
“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,” she stated.
Going forward, healthcare professionals face the challenge of striking a balance between the benefits of early detection and the risks associated with overdiagnosis and overtreatment. The hope lies in emerging technologies and research advancements, such as genetic testing, biomarker analysis, and sophisticated imaging tools. These innovations may help physicians identify high-risk individuals who are most likely to benefit from screening while minimizing the likelihood of unnecessary interventions in low-risk patients.
Looking Ahead: Implications for Men’s Health and Prostate Cancer Prevention
Prostate cancer continues to pose a significant public health challenge. The findings from this UCSF study underscore the urgent need for increased awareness, improved screening strategies, and better patient education. While the debate over universal screening guidelines persists, one fact remains clear—early detection can save lives, particularly among men with elevated risk factors.
Men are encouraged to engage in open discussions with their healthcare providers about prostate cancer screening, especially if they have a family history of the disease or belong to demographic groups at higher risk. Personalizing screening decisions ensures that men are informed and able to make choices that suit their individual circumstances.
As research advances, the medical community remains hopeful that more precise screening tools will emerge—tools capable of distinguishing between aggressive cancers that require immediate treatment and less threatening cases that can be safely monitored. Such breakthroughs will help protect men from unnecessary procedures while ensuring that those who need lifesaving interventions receive them in time.
A Call to Action
The UCSF study, published under the title Trends in Prostate Cancer Incidence and Mortality Rates in JAMA Network Open, was supported by the California Department of Public Health, the Centers for Disease Control and Prevention’s National Program of Cancer Registries, and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program.
Its findings send a powerful message: without vigilant screening and proactive healthcare policies, the fight against advanced prostate cancer risks losing hard-won ground. As California grapples with this concerning trend, the study offers a critical reminder that balancing early detection with cautious, individualized care remains the key to safeguarding men’s health.