Catherine, a freelance writer and editor based in Chicago, has written about healthcare and higher education for more than two decades. With 90-plus awards in communications, she is well-versed in storytelling.
With advanced-stage prostate cancer on the rise, physicians — and patients — urge screening
At 68 years old, John Lee noticed he was having trouble urinating. So he scheduled a doctor’s appointment that likely saved his life. The physician ran a prostate-specific antigen (PSA) blood test that revealed elevated levels of the protein in his blood.
Sometimes, elevated PSA levels stem from benign conditions, such as benign prostatic hyperplasia (commonly called BPH) or prostatitis. Lee’s subsequent scans and biopsies, however, revealed an aggressive, localized cancer.
“I was fortunate it hadn’t spread,” says Lee, now 71. The former Lake Forest, Illinois, resident now lives in Jacksonville. He adds, “If it had metastasized, I don’t know what the outcome would have been.”
Prostate cancer remains the most common cancer diagnosed among men in the United States, after skin cancer. After years of decline, new cases are rising, according to a 2025 report from the American Cancer Society (ACS). The report highlights an increase in advanced-stage diagnoses and continuing racial disparities in outcomes.
The ACS projects more than 333,000 new cases and approximately 36,000 deaths from prostate cancer in 2026. Between 2014 and 2021, annual diagnoses of prostate cancer rose approximately 3%, reversing earlier declines. Distant-stage cases — which have the lowest five-year survival rate at 38% — are climbing fastest.
“Because of these increases, mortality has declined only 0.6% annually over the past decade, compared with 3% to 4% per year previously,” says Tyler Kratzer, an associate scientist at the ACS and one of the study’s authors.
Older men are hardest hit. In Illinois, localized prostate cancer is rising 3.5% per year in men 70 and older.
Behind the rise
During the Covid-19 pandemic, fewer men went to the doctor, leading to a drop in PSA testing and a rise in advanced disease across all cancers, says Natalie Reizine, MD, a medical oncologist at UI Health.
But Kratzer says the pandemic alone doesn’t explain the trend. “We removed 2020 data because of the temporary dip in doctor visits,” he says. “There was no rebound in 2021, and the trend continued through 2022.”
The increase in advanced cases coincides with shifts in U.S. Preventive Services Task Force (USPSTF) guidelines. In 2012, the task force advised against routine PSA screening — a blood test that measures the PSA level — leading many men to skip annual checks.
“Well, no joke — we knew this,” says Marc Posner, MD, a radiation oncologist at Northwestern Medicine. “Guys stopped going to the doctor, and guess what? The incidence of prostate cancer went up. This isn’t a shock to anyone who treats prostate cancer.”
Posner says that the guideline change aimed to reduce overdiagnosis and overtreatment. “In the late 1990s and early 2000s, men were lining up to get treated, but we weren’t saving lives with that screening program,” he says. “Then the task force went too far, and men weren’t getting diagnosed, which now shows up as more advanced disease.”
By 2018, the USPSTF revised its stance, recommending that men discuss screening with their doctors rather than follow a blanket directive. “It’s more nuanced now,” Posner says. “It’s not just about age; it’s about risk. Some men may need to start in their 40s.”
Kratzer emphasizes that early detection is vital. “Men diagnosed early have a five-year survival rate approaching 100%, compared with 38% for distant-stage disease,” he says. “Early detection is crucial.”
After Lee’s diagnosis, he worked with his physician on a treatment plan and underwent eight weeks of targeted radiation. His care team at Northwestern also coordinated hormone therapy. And they warned him that he might experience some unpleasant side effects.
Lee started having hot flashes and frequently needed to urinate. But he continued working and traveling through it.
“I was on the road a lot, and my entire travel plan centered around where I could urinate,” he says. “But my doctors were transparent about side effects and outcomes, and that honesty really built trust.”
Now cancer-free, Lee urges men to be proactive. “Find a urologist and oncologist you trust,” he says. “If something doesn’t sound right, get a second opinion.”
Disparities persist
According to the American Cancer Society, Black men face the highest death rates from prostate cancer: 36.9 deaths per 100,000 people. American Indian and Alaska Native men also experience higher death rates than non-Hispanic white men, while Asian-American and Pacific-Islander men have the lowest death rates at 8.8 per 100,000 people.
A few factors contribute to the disparity, Posner says. “Minority groups often have worse outcomes because of stigma and distrust of doctors.”
Genetics, environment, and access to care also contribute to these disparities, Reizine says. But improved imaging can help. PSMA PET-CT scans detect metastatic disease earlier than [traditional] MRI, CT, or bone scans. “That helps guide treatment more precisely,” she says.
Communication is key. “Men need to talk about prostate cancer. There’s still stigma,” Lee says.
Posner agrees. “Most guys would rather ignore it than face it,” he says. “They are taught to be tough. They avoid doctors.”
Family history offers one starting point. “Understanding family history and talking with your doctor about screening benefits and harms is key,” Kratzer says. Current recommendations say men should start talking with their physicians about prostate cancer risk and concerns at age 50 for average-risk men, 45 for Black men or those with a family history, and 40 for men at highest risk.
“Screening isn’t one size fits all,” Reizine says. “We need better risk calculators, genetic testing, and imaging to identify who should be tested and when — balancing the risks of overdiagnosis with the danger of missing advanced disease.”
Lee urges men not to delay. He says — and is proof — that being proactive, asking questions, and getting screened can save your life.
