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Trends in prostate cancer mortality in the United States of America, by state and race, from 1999 to 2019: estimates from the centers for disease control WONDER database



In the United States of America (USA), prostate cancer (PC) is the most common cancer in men and the second cause of cancer mortality. Black men (BM) have a higher incidence and worse mortality when compared to white men (WM). We compared trends in PC mortality in the USA by race and state from 1999 to 2019.


We extracted PC mortality data from the Centers for Disease Control (CDC) WONDER database using the International Classification of Diseases (ICD) 10 code C61. Age-Standardized Mortality Rates (ASMR) were divided into racial groups and reported by year and state. Due to the lack of available data in many states, analyses were conducted only for WM and BM using Joinpoint regression for trend comparisons.


Between 1999–2019, ASMR decreased at the national level in Black (−44.6%), Asian (−44.8%), White (−31.8%), and American Indian or Alaskan native men (−19.0%). ASMR decreased in all states for both races. The greatest drop in ASMR was in Kentucky (−47.0%) for WM and Delaware (−57.8%) for BM. In 2019, ASMRs in BM (13.4/100 000) were significantly higher than WM (7.3/100 000), American Indian or Alaskan Native (3.2/100 000), and Asian men (3.2/100 000) (p < 0.001). The highest ASMRs were in Nebraska (33.5/100 000) for BM and Alaska (11/100 000) for WM.


During the last 20 years, the PC mortality rate dropped in all states for all races, suggesting an advancement in management strategies. Although a higher decrease in ASMR was observed in BM, ASMR remain higher among BM. ASMRs were also found to be increasing in many states post USPSTF guideline change (2012), indicating a need for more education around optimized prostate cancer screening.

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Fig. 1: Age-standardized mortality rates (ASMR) for Black and White males for prostate cancer (PC) in different states of the USA in 2019.
Fig. 2
Fig. 3: Interrupted time-series analysis showing changes in ASMR trends. (Post hoc analysis).

Data availability

The datasets generated during and/or analyzed during the current study are available in the WONDER database,


  1. Brawley OW. Trends in prostate cancer in the United States. J Natl Cancer Inst Monogr. 2012;2012:152–6.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kheirandish P, Chinegwundoh F. Ethnic differences in prostate cancer. Br J Cancer. 2011;105:481–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Rawla P. Epidemiology of Prostate Cancer. World J Oncol. 2019;10:63–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Center MM, Jemal A, Lortet-Tieulent J, Ward E, Ferlay J, Brawley O, et al. International variation in prostate cancer incidence and mortality rates. Eur Urol. 2012;61:1079–92.

    Article  PubMed  Google Scholar 

  5. Zargar H, van den Bergh R, Moon D, Lawrentschuk N, Costello A, Murphy D. The impact of the United States Preventive Services Task Force (USPTSTF) recommendations against prostate-specific antigen (PSA) testing on PSA testing in Australia. BJU Int. 2017;119:110–5.

    PubMed  Google Scholar 

  6. Barocas DA, Mallin K, Graves AJ, Penson DF, Palis B, Winchester DP, et al. Effect of the USPSTF Grade D Recommendation against Screening for Prostate Cancer on Incident Prostate Cancer Diagnoses in the United States. J Urol. 2015;194:1587–93.

    Article  PubMed  Google Scholar 

  7. Chou R, Dana T, Bougatsos C, Fu R, Blazina I, Gleitsmann K, et al.. Treatments for Localized Prostate Cancer: Systematic Review to Update the 2002 U.S. Preventive Services Task Force Recommendation [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Oct. Report No.: 12-05161-EF-1.

  8. DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin. 2019;69:211–33.

    Article  PubMed  Google Scholar 

  9. Friede A, Reid JA, Ory HW. CDC WONDER: a comprehensive on-line public health information system of the Centers for Disease Control and Prevention. Am J Public Health. 1993;83:1289–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Friede A, Rosen DH, Reid JA. CDC WONDER: a cooperative processing architecture for public health. J Am Med Inf Assoc. 1994;1:303–12.

    Article  CAS  Google Scholar 

  11. Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJL, Lozano R, Inoue M, editors. AGE STANDARDIZATION OF RATES: A NEW WHO STANDARD 2000.

  12. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19:335–51.

    Article  CAS  PubMed  Google Scholar 

  13. Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46:348–55.

    PubMed  Google Scholar 

  14. Penfold RB, Zhang F. Use of interrupted time series analysis in evaluating health care quality improvements. Acad Pediatr. 2013;13:S38–44.

    Article  PubMed  Google Scholar 

  15. Caswell JM Interrupted Time Series Analysis for Single Series and Comparative Designs: A Guide for Beginners with SAS Macro. 2019; Available at:

  16. Storholm ED, Siconolfi D, Huang W, Towner W, Grant DL, Martos A, et al. Project SLIP: Implementation of a PrEP Screening and Linkage Intervention in Primary Care. AIDS Behav. 2021;25:2348–57.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Garber SJ, Dhudasia MB, Flannery DD, Passarella MR, Puopolo KM, Mukhopadhyay S. Delivery-based criteria for empiric antibiotic administration among preterm infants. J Perinatol. 2021;41:255–62.

    Article  CAS  PubMed  Google Scholar 

  18. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021;71:7–33.

    Article  PubMed  Google Scholar 

  19. Cancer incidence and mortality in Nebraska: 2018. Available at: ( Accessed on 09/22/2022.

  20. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70:7–30.

    Article  PubMed  Google Scholar 

  21. Fletcher SA, Marchese M, Cole AP, Mahal BA, Friedlander DF, Krimphove M, et al. Geographic Distribution of Racial Differences in Prostate Cancer Mortality. JAMA Netw Open. 2020;3:e201839.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Nettey OS, Walker AJ, Keeter MK, Singal A, Nugooru A, Martin IK, et al. Self-reported Black race predicts significant prostate cancer independent of clinical setting and clinical and socioeconomic risk factors. Urol Oncol. 2018;36:501 e1–e8.

    Article  PubMed  Google Scholar 

  23. Chornokur G, Dalton K, Borysova ME, Kumar NB. Disparities at presentation, diagnosis, treatment, and survival in African American men, affected by prostate cancer. Prostate. 2011;71:985–97.

    Article  PubMed  Google Scholar 

  24. Hosain GM, Sanderson M, Du XL, Chan W, Strom SS. Racial/ethnic differences in predictors of PSA screening in a tri-ethnic population. Cent Eur J Public Health. 2011;19:30–4.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lee DJ, Barocas DA, Zhao Z, Huang LC, Koyama T, Resnick MJ, et al. Contemporary prostate cancer radiation therapy in the United States: Patterns of care and compliance with quality measures. Pract Radiat Oncol. 2018;8:307–16.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Moses KA, Paciorek AT, Penson DF, Carroll PR, Master VA. Impact of ethnicity on primary treatment choice and mortality in men with prostate cancer: data from CaPSURE. J Clin Oncol. 2010;28:1069–74.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Berglund A, Garmo H, Robinson D, Tishelman C, Holmberg L, Bratt O, et al. Differences according to socioeconomic status in the management and mortality in men with high risk prostate cancer. Eur J Cancer. 2012;48:75–84.

    Article  PubMed  Google Scholar 

  28. Coughlin SS. A review of social determinants of prostate cancer risk, stage, and survival. Prostate Int. 2020;8:49–54.

    Article  PubMed  Google Scholar 

  29. Du XL, Fang S, Coker AL, Sanderson M, Aragaki C, Cormier JN, et al. Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma: findings from a large community-based cohort. Cancer. 2006;106:1276–85.

    Article  PubMed  Google Scholar 

  30. Schwartz K, Powell IJ, Underwood W 3rd, George J, Yee C, Banerjee M. Interplay of race, socioeconomic status, and treatment on survival of patients with prostate cancer. Urology. 2009;74:1296–302.

    Article  PubMed  Google Scholar 

  31. Krimphove MJ, Cole AP, Fletcher SA, Harmouch SS, Berg S, Lipsitz SR, et al. Evaluation of the contribution of demographics, access to health care, treatment, and tumor characteristics to racial differences in survival of advanced prostate cancer. Prostate Cancer Prostatic Dis. 2019;22:125–36.

    Article  PubMed  Google Scholar 

  32. George DJ, Heath EI, Sartor AO, Sonpavde G, Berry WR, Healy P, et al. Abi Race: A prospective, multicenter study of black (B) and white (W) patients (pts) with metastatic castrate resistant prostate cancer (mCRPC) treated with abiraterone acetate and prednisone (AAP). Journal of Clinical Oncology. 2018;36(18_suppl):LBA5009-LBA.

    Article  Google Scholar 

  33. Halabi S, Dutta S, Tangen CM, Rosenthal M, Petrylak DP, Thompson IM Jr., et al. Overall Survival of Black and White Men With Metastatic Castration-Resistant Prostate Cancer Treated With Docetaxel. J Clin Oncol. 2019;37:403–10.

    Article  CAS  PubMed  Google Scholar 

  34. Yamoah K, Lee KM, Awasthi S, Alba PR, Perez C, Anglin-Foote TR, et al. Racial and Ethnic Disparities in Prostate Cancer Outcomes in the Veterans Affairs Health Care System. JAMA Netw Open. 2022;5:e2144027.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Negoita S, Feuer EJ, Mariotto A, Cronin KA, Petkov VI, Hussey SK, et al. Annual Report to the Nation on the Status of Cancer, part II: Recent changes in prostate cancer trends and disease characteristics. Cancer. 2018;124:2801–14.

    Article  PubMed  Google Scholar 

  36. Cetnar JP, Hampton JM, Williamson AA, Downs T, Wang D, Owen JB, et al. Place of residence and primary treatment of prostate cancer: examining trends in rural and nonrural areas in Wisconsin. Urology. 2013;81:540–6.

    Article  PubMed  Google Scholar 

  37. Obertova Z, Brown C, Holmes M, Lawrenson R. Prostate cancer incidence and mortality in rural men–a systematic review of the literature. Rural Remote Health. 2012;12:2039.

    CAS  PubMed  Google Scholar 

  38. Maganty A, Sabik LM, Sun Z, Eom KY, Li J, Davies BJ, et al. Under Treatment of Prostate Cancer in Rural Locations. J Urol. 2020;203:108–14.

    Article  PubMed  Google Scholar 

  39. 2010 Census Urban and Rural Classification and Urban Area Criteria. Available at: Accessed on 09/22/2022.

  40. Accessed on 10/4/2022.

  41. Hoffman RM, Li J, Henderson JA, Ajani UA, Wiggins C. Prostate cancer deaths and incident cases among American Indian/Alaska Native men, 1999-2009. Am J Public Health. 2014;104(Suppl 3(Suppl 3)):S439–45.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Espey DK, Wu XC, Swan J, Wiggins C, Jim MA, Ward E, et al. Annual report to the nation on the status of cancer, 1975-2004, featuring cancer in American Indians and Alaska Natives. Cancer. 2007;110:2119–52.

    Article  PubMed  Google Scholar 

  43. Henderson JA, Espey DK, Jim MA, German RR, Shaw KM, Hoffman RM. Prostate cancer incidence among American Indian and Alaska Native men, US, 1999-2004. Cancer. 2008;113(5 Suppl):1203–12.

    Article  PubMed  Google Scholar 

  44. Kim IE Jr., Jang TL, Kim S, Modi PK, Singer EA, Elsamra SE, et al. Abrogation of survival disparity between Black and White individuals after the USPSTF's 2012 prostate-specific antigen-based prostate cancer screening recommendation. Cancer. 2020;126:5114–23.

    Article  CAS  PubMed  Google Scholar 

  45. Schroder FH, Hugosson J, Roobol MJ, Tammela TL, Zappa M, Nelen V, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014;384:2027–35.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Screening for Prostate Cancer in Older Patients (PLCO Screening Trial).

  47. Tsodikov A, Gulati R, Heijnsdijk EAM, Pinsky PF, Moss SM, Qiu S, et al. Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials. Ann Intern Med. 2017;167:449–55.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Eapen RS, Herlemann A, Washington SL 3rd, Cooperberg MR. Impact of the United States Preventive Services Task Force ‘D’ recommendation on prostate cancer screening and staging. Curr Opin Urol. 2017;27:205–9.

    Article  PubMed  Google Scholar 

  49. Basourakos SP, Gulati R, Vince RA, Spratt DE, Lewicki PJ, Hill A, et al. Harm-to-Benefit of Three Decades of Prostate Cancer Screening in Black Men. NEJM Evidence. 2022;1:EVIDoa2200031.

    Article  Google Scholar 

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Each of the authors significantly contributed to this manuscript. CJ, CM, NA, JS, JSH, and RRM made significant contributions to the concept and design of this paper. CJ, JS, and DM were significantly involved in the statistical analysis. CJ, CM, NA, CJ, JS, DM, HS, IS, JSH, and RRM extensively drafted the manuscript. RRM, IS, CJ, CM, RRA and JSH were involved in the critical revision of the manuscript and contributed important intellectual content. CJ (corresponding author, guarantor) takes responsibility for the manuscript’s content, including the data and analysis.

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Correspondence to Chinmay Jani.

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Jani, C., Mouchati, C., Abdallah, N. et al. Trends in prostate cancer mortality in the United States of America, by state and race, from 1999 to 2019: estimates from the centers for disease control WONDER database. Prostate Cancer Prostatic Dis 26, 552–562 (2023).

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