Aggressive prostate cancer is surging in California. What you need to know

Advanced prostate cancer cases are rising sharply in California, outpacing national trends, according to a new study from UC San Francisco.

The alarming trend underscores the need for smarter screening to catch aggressive cases early without simultaneously triggering care for harmless tumors, experts said.

“This rise is happening across all ages, ethnicities and regions in California,” said Erin Van Blarigan, a UCSF epidemiologist and the study’s lead author.

Researchers found that between 2011 and 2021, the number of men diagnosed with late-stage prostate cancer increased by 6.7% per year in California — significantly higher than the national rate of 4.5% per year over roughly the same period. The study, published last week in JAMA Network Open, also found that after years of decline, prostate cancer mortality rates have stalled in much of the state.

Prostate cancer is the most common cancer among men in the U.S. and a leading cause of cancer-related deaths. Some tumors grow so slowly that they never cause harm, while others spread quickly and require urgent treatment. The go-to screening method — the prostate-specific antigen (PSA) test — can’t always tell the difference, which has led to concerns about unnecessary procedures.

In 2012, the U.S. Preventive Services Task Force recommended stopping routine PSA screenings to prevent unnecessary surgeries and complications. However, in 2018, the panel adjusted its stance, advising men between 55 and 69 to talk with their doctors about screening options. Despite this, Van Blarigan said rates continue to rise.

“We absolutely need to screen — that’s the bottom line,” she said. “But we have to do it smarter.”

More about the research

The UCSF study analyzed nearly 388,000 prostate cancer cases in California from 2004 to 2021. Researchers found that 7.2% of those cases were diagnosed at an advanced stage, where the five-year survival rate drops to just 37%. Over the same period, nearly 59,000 men in California died from the disease.

The Central Coast saw the fastest increase in advanced cases, rising 9.1% per year, while the Southern San Joaquin Valley had the slowest rise at 2.3% per year. The highest mortality rates were in the Inland Empire, San Diego-Imperial and North Coast regions, while the San Francisco Bay Area had the lowest.

What's next

Van Blarigan said the next step is to find out why rates vary geographically.

Scientists are studying advanced imaging technologies and biomarker tests that could help doctors determine a patient’s risk more accurately, reducing the need for one-size-fits-all screening approaches. Van Blarigan emphasized the importance of staying informed and proactive about personal health.

“It’s worth asking [your doctor] if a PSA test makes sense for you,” she said. “Then, based on your results, you and your doctor can decide the next steps.”

The Preventive Services Task Force is reviewing its prostate cancer screening guidelines again, with updates expected soon. In the meantime, California’s rising late-stage diagnoses are a wake-up call: Early detection still matters, and knowing your risks could save your life.