Prostate cancer plummets: Incidence and mortality rates in free fall

Richard Mark Kirkner

The American age-adjusted incidence rate for prostate cancer peaked in 1992 at 237.4 per 100,000 men with the advent of widespread PSA screening and has been falling fast ever since.


Cases per 100,000 men

In 2012, the U.S. Preventive Services Task Force came out against PSA screening, citing evidence that a “substantial percentage” of men who have asymptomatic cancer detected by a PSA test have prostate cancer that either will not progress or will progress so slowly that it would have remained asymptomatic. Interestingly, the argument against screening is similar to the one for active surveillance — that there’s no need to rush into treatment of a cancer that is small and slow growing. Critics of the task force’s screening recommendation say that active surveillance would answer one of the key objections to screening, which is that it leads to overtreatment. The rebuttal is that if those screen-detected cancers hadn’t been discovered, active surveillance and all the biopsies it entails wouldn’t be necessary.

The age-adjusted mortality rate for prostate cancer peaked in 1993 — just a year after the incidence rate did — at 39.3 per 100,000 men. Explanations for the decline in the mortality rate range from improvements in treatment to American men having healthier diets. Advocates of screening say early detection has also had a hand in bending the mortality-rate curve.


Deaths per 100,000 men

Source: National Cancer Institute, SEER Cancer Statistics Review 1975–2012