Movember 2025: Prostate Cancer U.S. Mortality Trends Update
Plus a link to discussion about PSA screening
Thanks to everybody who has donated to my Movember fundraiser! We’ve gotten off to a great start!
First, plugging the fundraiser:
Movember 2025 Fundraiser
Here are the places you can donate to the Movember Foundation, which supports men’s health, specifically focusing on prostate cancer, testicular cancer, and men’s mental health:
Mary Pat Campbell’s MoSpace – a place to donate at Movember itself
My Movember Facebook fundraiser – my officially linked fundraiser, if this works better for you
And here’s a QR code if that works better for you:
Prostate Cancer U.S. Death Rates: High-Level Trend
I will break this out by age group momentarily, but this hasn’t been looking great.
Since about 2012, the age-adjusted death rate for prostate cancer has flatlined.
Yes, the crude rate has increased, but that doesn’t concern me as much — that’s primarily the aging of the population. Age-adjusted death rates correct for that… and yet, the death rate hasn’t improved. Why not?
This is obviously not a pandemic (only) effect.
Prostate Cancer Death Rates: Breakdown by Age Groups
When broken out by the 10-year age groups, you can see the magnitude differences, which obviously climb with age.
If I gave you the numbers of deaths by age groups, the most actually occur in the age 75 - 84 years bucket, from a combination of rate and how many men are alive in that grouping to suffer from prostate cancer. While the rate is much higher over age 85, there aren’t as many men alive past that age.
On Age-Adjusted Death Rates
Now, while there is an obvious bend in the age 85+ death rates past 2012, don’t assume that it is only their experience that is driving the age-adjusted death rate. The weights given for calculating age-adjusted death rates are as follows: (from the CDC)
So you see that the age 85+ group gets only a 1.55% weight.
By the way, the weighting for standardized age-adjusted death rates are updated every 30 years (before the 2000 standard, there were the 1970 and 1940 standards), so we’ll be having a new standard weighting in a few years.
But let’s see how the different age groups have seen their death rates change.
Changes in Prostate Cancer Death Rates by Age Group
By decade
Let’s start with the good news: the huge improvements — the large negative results in 2004 are decreases in death rates from 1994 to 2004, which is very good. It continued into the next decade.
1994 was a key year for the PSA test, as noted in this profile of the man who developed it: The man behind the PSA test
Deemed one of the landmark discoveries of the 20th century, the prostate-specific antigen (PSA) traces its history to Roswell Park Comprehensive Cancer Center. More than three million American men alive in 2021 are prostate cancer survivors, according to the American Cancer Society. And most can thank the test, developed at Roswell Park, for playing a central role in their beating the odds.
T. Ming Chu, PhD, DSc, Chair Emeritus of Diagnostic Immunology Research and Professor Emeritus of Urologic Oncology, led the research in the 1970s that resulted in the discovery of PSA and the development of the PSA test, the diagnostic test heard around the world. Every year, 20 million American men, and a similar number worldwide, take the PSA test, the centerpiece in the early warning system for prostate cancer.
….
A patent was issued in 1984 to the state of New York and Roswell Park. The technology was transferred to the biomedical industry for preparing testing kits. The PSA test received FDA approval in 1986 as a monitor for treatment response and disease recurrence, and in 1994, as a early detection aid for diagnosis. Since then, more than an estimated one billion PSA tests have been given.
I added that emphasis there.
I will come back to it in a moment.
There was a great improvement in prostate cancer mortality post-institution of the PSA test, and while there were other reasons for prostate cancer mortality improvement as well at the time, it obviously helped after decades of “disimprovement” seen from 1974 - 1994. Most of the increase came at the oldest ages in those earlier decades.
2019-2024, year-by-year
You might want to ignore the 45-54 year-old mortality, as that’s comparing small numbers against each other. Only a few dozen men die from prostate cancer that young each year.
But starting at age 55, the rates start kicking up.
I have a comparison to 2019, cumulatively, because I had many cause-of-death rates compared against 2019 to look at potential pandemic disruptions. It doesn’t seem that there were appreciable pandemic-specific disruptions here. There may be some slight increases at older ages due to decreased screening, as seen with President Biden, but that has nothing to do with the pandemic and more to do with a change in recommendations over a decade ago.
Discussion on PSA Screening for Prostate Cancer
3 Nov 2025, Sensible Medicine, John Mandrola: The PSA Screening Test and Humility
I am old enough to have had a prostate specific antigen (PSA) test discussion with my doctor. I initially refused but in a recent moment of weakness gave in.
The 23-year follow-up results of the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial (in NEJM) reinforces my initial opposition to being screened with a PSA test.
One does not do science by anecdote, obviously.
Widespread cancer screening and screening recommendations are controversial.
Let us look at the paper Mandrola is responding to:
29 Oct 2025, NEJM: European Study of Prostate Cancer Screening — 23-Year Follow-up
Methods
We updated the findings from ERSPC, a multicenter, randomized study conducted across eight European countries with a focus on a predefined core age group of 162,236 men who were 55 to 69 years of age at the time of randomization. Participants were randomly assigned to the screening group and offered repeated PSA testing or to the control group and not invited for screening. The primary outcome was prostate cancer mortality.
Results
After a median follow-up of 23 years, prostate cancer mortality was 13% lower in the screening group (rate ratio, 0.87; 95% confidence interval [CI], 0.80 to 0.95), and the absolute risk reduction was 0.22% (95% CI, 0.10 to 0.34). The cumulative incidence of prostate cancer was higher in the screening group than in the control group (rate ratio, 1.30; 95% CI, 1.26 to 1.33). At a median of 23 years of follow-up, one death from prostate cancer was prevented for every 456 men (95% CI, 306 to 943) who were invited for screening, and one death from prostate cancer was averted for every 12 men (95% CI, 8 to 26) in whom prostate cancer was diagnosed, as compared with one death from prostate cancer prevented for every 628 men (95% CI, 419 to 1481) and one death averted for every 18 men (95% CI, 12 to 45) at 16 years of follow-up.
There is a “higher incidence” of cancer among those screened… because one looked for the cancer. Obviously, if you don’t look for the cancer, you don’t find it… unless it becomes so bad you can’t ignore it (or they were screened outside the trial). Some tumors never really grow much, and you will die from something else before the cancer ever does anything.
I mentioned that here:
People are concerned about false positives, or about getting biopsies, all of which engender worry. PSA tests can bring back high results without any cancer being involved.
Part of the problem is that just because you don’t look for cancer doesn’t mean it’s not there. And doesn’t mean it won’t spread to your entire body.
President Biden Had Followed Bad Prostate Cancer Screening Guidelines -- Here are Better Ones
Some people were incredulous when they saw this news, but I was not:
It’s better to be treated for early-stage prostate cancer before it spreads outside the prostate, as with our current state of medicine, the early stages are potentially curable at very high rates.
Currently, advanced prostate cancer is not curable, merely treatable. All of the negative results you’re worrying about for prostate cancer treatment are far worse for advanced prostate cancer. (Not just death.)
These are all the considerations people need to think about when considering risk-related decisions on cancer screening.
It may go one way when you’re 85 versus when you’re 55.
Movember link on prostate cancer: do you know your risk?
Spreadsheet
