Prostate Cancer: Where It Is Found, Where Men Die, and Who Is Most at Risk

Prostate cancer is the most commonly diagnosed cancer in men in most of the world's countries, with about 1.5 million new cases and 420,000 deaths in 2024. Where it is found most often is not where men are most likely to die of it. And in the US and England, two countries with good data by ethnicity, Black men are diagnosed at 1.7 to 2.1 times the rate of White men and die of it at about twice the rate.

For many men, prostate cancer is found early, watched carefully and never becomes life-threatening. For others, especially where diagnosis comes late and treatment is hard to reach, it is a leading cause of death. This study, part of our cancer research library, sets out the global figures, the higher risk for Black men, the debate about testing with prostate-specific antigen (PSA) and the evidence on active surveillance.

The most common cancer in men in 123 countries, but deaths follow a different map

GLOBOCAN 2024, the International Agency for Research on Cancer's latest global estimates, estimates 1,546,112 new prostate cancer cases in 2024, 7.5% of all cancers diagnosed worldwide, and 419,849 deaths. It is the most frequently diagnosed cancer in men in 123 of 186 countries. The age-standardised incidence rate worldwide was 29.3 per 100,000 men and the mortality rate 7.5 per 100,000^[1].

Recorded incidence varies more than 11-fold between world regions, with the highest rates (70 or more per 100,000) in Northern America, Northern Europe, Australia and New Zealand, and the Caribbean. Rates in higher Human Development Index (HDI) countries are almost three times those in lower HDI countries (34.9 versus 13.1 per 100,000). Mortality hardly differs between the two (7.4 versus 6.9 per 100,000), and death rates are disproportionately high in the Caribbean, sub-Saharan Africa and Micronesia/Polynesia. Prostate cancer is the leading cause of cancer death in men in 68 countries, including many in the Caribbean and sub-Saharan Africa, several in Central and South America, and Sweden^[1].

Much of the gap in incidence is about detection, not disease. GLOBOCAN's authors write that much of the international variation in prostate cancer incidence "reflects difference in diagnostic practices at the national level". In Northern America, parts of Northern Europe and Australia, rates rose sharply in the late 1980s and early 1990s with the arrival of PSA testing, then fell. Incidence is still rising in China, India, the Baltic countries and Eastern Europe^[1]. A study of 12 population-based registries in 11 sub-Saharan African countries found incidence rising in all of them, and statistically significantly in all but one. The authors said the reasons were largely unclear but believed they were primarily improvements in health systems, including wider use of PSA testing^[3]. The wider picture for cancer in lower-income countries is covered in our study of the global cancer gap.

Advancing age, family history and certain inherited genetic variants remain the only well-established risk factors; evidence on smoking, body weight and diet is inconclusive^[1]. Inherited variants such as BRCA2 are covered in our study of inherited cancer risk.

The Lancet Commission on prostate cancer, using IARC trend-based projections that assume current trends continue, estimated that annual cases would rise from 1.4 million in 2020 to 2.9 million by 2040, and deaths by 85%, from 375,000 to close to 700,000. It noted that this rise "cannot be prevented by lifestyle changes or public health interventions alone"^[4].

Found early, survival is close to that of other men; found late, it is not

In the United States, five-year relative survival for prostate cancer (survival compared with men of the same age in the general population) was 98% for men diagnosed in 2015 to 2021. For cancer confined to the prostate (localised) or spread only to nearby tissue or lymph nodes (regional) at diagnosis, it was above 99%. For cancer that had spread to distant parts of the body, it was 38%^[2]. The report's authors note that earlier detection improves survival figures partly through better treatment and partly through lead time (diagnosis before symptoms) and overdiagnosis (finding slow-growing tumours that would never have caused harm)^[2].

The picture in much of sub-Saharan Africa is very different. A registry study drew a random sample of 1,752 men registered with prostate cancer between 2005 and 2015 in 12 population-based registries across 10 countries. Of men whose stage was known, 45.2% were diagnosed at stage IV, the most advanced stage, and only 23.6% at stage I or II. Five-year relative survival for the whole group was 60.0%. Each 0.1 rise in a country's HDI was associated with a 20% lower excess risk of death^[5].

The periods, registries and methods differ, so the rows are not a like-for-like comparison. Sources: Siegel et al. 2026^[2]; Seraphin et al. 2021^[5].

The Lancet Commission puts the global divide plainly: "Underdiagnosis and undertreatment cause harm in LMICs; overdiagnosis and overtreatment lead to different harms in HICs." It reports that more than half of men in low- and middle-income countries already have advanced disease when diagnosed. It also documents the gaps in services: in Africa, one urologist for every 75 to 115 cases of prostate cancer, against one for every 50 cases in the UK, and, citing the 2015 Lancet Commission on radiotherapy, up to 90% of patients in low-income countries with no access to it^[4].

Black men are diagnosed at 1.7 to 2.1 times the rate of White men in the US and England, and services need to plan for it

Each figure below measures something different.

• United States, incidence. For 2018 to 2022, the age-adjusted incidence rate was 198.9 per 100,000 Black men against 118.4 per 100,000 White men (both groups excluding Hispanic men), about 1.7 times higher^[2].
• United States, mortality. For 2019 to 2023, the age-adjusted death rate was 36.9 per 100,000 Black men against 18.4 per 100,000 White men, about twice as high. The American Cancer Society's report describes Black men's prostate cancer death rates as "approximately two to four times those in all other men"^[2].
• England, incidence. Using almost 3 million cancer diagnoses in 2013 to 2017, age-standardised prostate cancer incidence was 2.1 times higher in Black men than in White men^[6].
• England, lifetime risk. An estimate for 2008 to 2010 put the lifetime risk of a prostate cancer diagnosis at about 1 in 4 for Black men (29.3%), 1 in 8 for White men (13.3%) and 1 in 13 for Asian men (7.9%). The lifetime risk of dying from it was about 1 in 12 for Black men, 1 in 24 for White men and 1 in 44 for Asian men. The authors note that ethnicity data were incomplete and needed adjustment^[7].

The English lifetime-risk study also found that once diagnosed, White, Black and Asian men in England were all as likely to die from the disease, so the higher risk of dying from it tracks the higher risk of being diagnosed^[7]. In the US, five-year relative survival for men diagnosed in 2015 to 2021 was 97% for Black men and 99% for White men, a small gap compared with the gap in death rates^[2].

Why the risk is higher is not fully known. GLOBOCAN's authors say higher incidence in the Caribbean and sub-Saharan Africa may partly reflect genetic variants linked to risk that are more common in men with West African ancestry^[1]. The Lancet Commission notes that most research on the genetics and epidemiology of prostate cancer has been done in White populations, and that in the UK it is unclear whether higher mortality among Black men "is driven by differences in incidence, differing disease biology, or external factors such as deprivation or racism"^[4].

This is not a reason for alarm in any one man. It is a population fact, measured repeatedly in two countries, and it should shape where services put information, diagnostic capacity and research. Differences across many cancers are covered in our study of ethnicity and cancer.

PSA testing saves some lives and finds many cancers that would never have caused harm

The largest trial, the European Randomized Study of Screening for Prostate Cancer (ERSPC), randomised 162,236 men aged 55 to 69 in eight European countries to repeated PSA testing or no invitation. After a median of 23 years, prostate cancer mortality was 13% lower in the screening group (rate ratio 0.87), an absolute reduction of 0.22 percentage points. One prostate cancer death was prevented for every 456 men invited, and for every 12 men diagnosed. At 16 years the figures had been 628 and 18, so the balance has improved with time. The screening group also had 30% more prostate cancers diagnosed (rate ratio 1.30)^[8]. Some of those extra cancers would never have caused symptoms, and treating them can bring side effects. The UK National Screening Committee names incontinence and erectile dysfunction as the main harms for men who did not need treatment^[9].

Population data show what happens when testing changes. In the US, incidence fell after recommendations against routine screening, then rose by 2.9% a year from 2014 to 2022, with steeper rises in cancers diagnosed at regional stage (4.6% a year since 2013) and distant stage (5.6% a year since 2011). The US death rate in 2023 was 53% below its 1993 peak, but the decline has slowed from 3.5% a year to 0.6% a year since 2012^[2]. GLOBOCAN's authors say the rise in advanced-stage diagnoses is thought to reflect, in part, reduced PSA testing^[1].

The UK decision, 2025 to 2026

The UK National Screening Committee completed its latest review in March 2026. It does not recommend screening the whole male population. It recommends a targeted programme of PSA testing every two years for men aged 45 to 61 who have a disease-causing BRCA2 variant and a family history of breast, ovarian, pancreatic or prostate cancer, and does not recommend targeted screening for any other group. On Black men, it says "there is ongoing uncertainty as to whether screening would cause more good than harm"^[9]. A November 2025 draft had also included men with BRCA1 variants; the final version dropped them because the evidence for BRCA1 was not consistent. The UK Government accepted the recommendation for England by early June 2026, with roll-out expected from 2027; the other UK nations were still considering it^[10].

The evidence gap the committee identifies is real, and it is a gap in research, not in the men concerned: most screening trials were run largely in majority-White populations, and the value of population PSA testing in low- and middle-income countries has never been assessed^[4]. The TRANSFORM trial in the UK, led by Prostate Cancer UK with the backing of the NHS, the National Institute for Health and Care Research and the UK Government, is testing screening options including PSA, fast MRI and genetic testing against current practice. It commits to at least 1 in 10 men invited to its first stage being Black men, and plans to invite eligible Black men aged 45 to 74 in its second stage^[11]. Screening for other cancers is covered in our study of screening uptake.

Active surveillance: death rates stay low, but use varies widely

Active surveillance means monitoring a low-risk cancer and treating only if it progresses. The UK ProtecT trial followed 1,643 men with localised prostate cancer found by PSA testing in 1999 to 2009, randomised to active monitoring, surgery or radiotherapy; more than a third had intermediate- or high-risk disease at diagnosis. After a median of 15 years, 2.7% had died of prostate cancer: 3.1% in the monitoring group, 2.2% after surgery and 2.9% after radiotherapy, a difference that was not statistically significant. Spread of cancer (metastases) was more common with monitoring (9.4%, against 4.7% and 5.0%), and 24.4% of the monitoring group were alive without any prostate cancer treatment at the end^[12].

In US practice, use of active surveillance for low-risk prostate cancer in a national urology registry rose from 26.5% in 2014 to 59.6% in 2021. It varied from 4.0% to 78.0% between urology practices and from 0% to 100% between individual practitioners, and age, race and PSA level were all associated with the odds of surveillance^[13]. The Lancet Commission argues that early detection programmes should be "explicitly linked to increased utilisation of active surveillance"^[4].

What the evidence asks of us

The priorities differ by setting, but the principle is the same: find the cancers that matter in time, and avoid harming men with cancers that never would.

• Plan now for the rise in cases. The Lancet Commission's projection of 2.9 million cases a year by 2040 is a trend-based estimate, not a certainty, but it calls on governments to prepare strategies now^[4].
• Close the late-diagnosis gap where it is widest. Where nearly half of men are diagnosed at stage IV, investment in health systems, awareness and earlier diagnosis is what the registry evidence calls for^[5], alongside the surgical and radiotherapy capacity the Lancet Commission found missing^[4].
• Respond to the higher risk for Black men as a planning fact. A diagnosis rate 1.7 to 2.1 times that of White men in the US and England is a reason for services to reach Black men with clear information, accessible diagnostic services and fair representation in trials. The Lancet Commission recommends sociodemographically targeted education and early-diagnosis programmes in high-risk populations, and says the case for screening men of African origin from age 45 in high-income countries is strengthening^[4]. The UK committee has concluded that it is still uncertain whether screening Black men would do more good than harm^[9]. Trials such as TRANSFORM, designed to include Black men, are how that question gets answered^[11].
• Pair detection with restraint. ERSPC's authors call for risk-based approaches that minimise overdiagnosis^[8]. The wide variation in active surveillance between practices^[13] suggests that consistent standards matter as much as the test itself.
• Fund the missing research, particularly outside White populations and high-income countries^[4].

Language: this piece says "people with cancer" and "people living with and after cancer", and describes the illness and its treatment plainly, without combat metaphors. Clinical terms such as "stage", "incidence" and "relative survival" are used in the sense the cited source defines them.

Why we're publishing this

Prostate cancer charities and support groups make the case for earlier diagnosis, fairer access and better research every day. We want them to have the core figures in one place, sourced and stated carefully, including exactly what the higher risk for Black men measures. The case is theirs, and the men and families they support deserve evidence presented without either alarm or complacency.

How to read this data

• Incidence is not the same as risk of harm. Recorded incidence depends heavily on how much testing happens. High incidence in a wealthy country partly reflects detection of slow-growing cancers; low incidence elsewhere can hide undiagnosed disease.
• Rates. GLOBOCAN figures are age-standardised to the world population; US figures are age-adjusted to the 2000 US standard population. The two cannot be compared directly.
• Survival. The US and sub-Saharan African figures cover different periods and registries. High survival partly reflects lead time and overdiagnosis.
• Ethnicity. Good data by ethnicity come mainly from the US and England, and use different categories. The English lifetime-risk figures are older (2008 to 2010) and relied on adjustments for incomplete ethnicity data. "Black" groups together men of very different ancestries and experiences.
• Trials. ERSPC began in 1993 and ProtecT tested men in 1999 to 2009; diagnostic practice, including the use of MRI, has changed since. Most screening trials have been run largely in majority-White populations in high-income countries.

Use this data

Free to cite with attribution to Better Health For Everyone. Charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research for general information. It is not medical advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's health, please speak to a qualified health professional.

Sources

1. Sung H, Filho AM, Laversanne M, Ferlay J, Siegel RL, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2024: GLOBOCAN estimates of incidence and mortality worldwide for 34 cancers in 186 countries. CA: A Cancer Journal for Clinicians, 2026. europepmc.org/article/PMC/PMC13343830
2. Siegel RL, Kratzer TB, Wagle NS, Sung H, Jemal A. Cancer statistics, 2026. CA: A Cancer Journal for Clinicians, 2026. europepmc.org/article/PMC/PMC12798275
3. Seraphin TP, Joko-Fru WY, Kamaté B, et al. Rising prostate cancer incidence in sub-Saharan Africa: a trend analysis of data from the African Cancer Registry Network. Cancer Epidemiology, Biomarkers & Prevention, 2021. europepmc.org/article/MED/33033143
4. James ND, Tannock I, N'Dow J, et al. The Lancet Commission on prostate cancer: planning for the surge in cases. The Lancet, 2024. europepmc.org/article/PMC/PMC7617369
5. Seraphin TP, Joko-Fru WY, Manraj SS, et al. Prostate cancer survival in sub-Saharan Africa by age, stage at diagnosis, and human development index: a population-based registry study. Cancer Causes & Control, 2021. europepmc.org/article/MED/34244896
6. Delon C, Brown KF, Payne NWS, et al. Differences in cancer incidence by broad ethnic group in England, 2013–2017. British Journal of Cancer, 2022. europepmc.org/article/MED/35233092
7. Lloyd T, Hounsome L, Mehay A, et al. Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008–2010. BMC Medicine, 2015. europepmc.org/article/MED/26224061
8. Roobol MJ, de Vos II, Månsson M, et al. European Study of Prostate Cancer Screening — 23-year follow-up. New England Journal of Medicine, 2025. europepmc.org/article/MED/41160819
9. UK National Screening Committee. Prostate cancer: screening recommendation (2025 to 2026 review). GOV.UK, 2026. view-health-screening-recommendations.service.gov.uk/prostate-cancer
10. Cancer Research UK. UK NSC recommends prostate cancer screening for men with a BRCA2 gene change and family history of cancer (28 May 2026, updated 2 June 2026). Cancer Research UK, 2026. news.cancerresearchuk.org/2026/05/28/uk-nsc-recommends-prostate-cancer-screening…
11. Prostate Cancer UK. The TRANSFORM trial. Prostate Cancer UK, 2026. prostatecanceruk.org/research/transform-trial
12. Hamdy FC, Donovan JL, Lane JA, et al. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. New England Journal of Medicine, 2023. europepmc.org/article/MED/36912538
13. Cooperberg MR, Meeks W, Fang R, et al. Time trends and variation in the use of active surveillance for management of low-risk prostate cancer in the US. JAMA Network Open, 2023. europepmc.org/article/MED/36862409