Prostate cancer mortality trends in the US (1999–2020).

e23055 Background: Prostate cancer remains a leading cause of cancer-related mortality among U.S. men. This study evaluates mortality trends from 1999 to 2020, highlighting disparities across demographics, geographic regions, and socioeconomic factors. Methods: CDC WONDER data for adults aged 25+ were analyzed. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated by race/ethnicity, region, and urbanization level. Trends were assessed using Joinpoint regression to determine average annual percentage change (AAPC) with 95% confidence intervals (CIs). Results: Prostate cancer caused 925,141 deaths from 1999 to 2020. AAMRs declined from 25.8/100,000 (95% CI 25.5–26.0) in 1999 to 17.9/100,000 (95% CI 17.7–18.1) in 2020 (AAPC: -1.77%; 95% CI -1.94 to -1.68; p < 0.000001). Black men had the highest AAMR (36/100,000; 95% CI 35.8–36.2), while Asians/Pacific Islanders had the lowest (8.4/100,000; 95% CI 8.3–8.5). The steepest decline was among Black men (AAPC: -2.60%; 95% CI -2.85 to -2.35; p < 0.000001). The decline for American Indians/Alaska Natives (-0.93%; 95% CI -1.78 to 0.17) was not statistically significant (p = 0.083583). The South had the highest total deaths (328,984), while the West had the highest AAMR (20.4/100,000; 95% CI 20.3–20.5). Declines were significant in all regions, with the sharpest in the Northeast (-2.17%; 95% CI -2.45 to -1.93) and the smallest in the West (-1.64%; 95% CI -1.82 to -1.46). Urban areas accounted for 746,089 deaths (AAMR: 19.2/100,000), while rural areas had higher AAMRs (21.2/100,000; 95% CI 21.1–21.3). Mortality declined significantly in both urban (AAPC: -1.79%; 95% CI -1.99 to -1.69) and rural areas (AAPC: -1.61%; 95% CI -1.87 to -1.43). State-level data showed the highest AAMR in D.C. (30.3/100,000) and the lowest in Hawaii (15.4/100,000). California had the most deaths (104,495), while Alaska had the fewest (1,110). Conclusions: Prostate cancer mortality rates have significantly declined across all demographics and regions from 1999 to 2020. However, Black men continue to experience disproportionately high mortality rates. Addressing these racial and regional disparities should remain a public health priority to ensure equitable progress in cancer care outcomes. Cohort Age Adjusted Mortality Rate per Million Average Annual Percentage Change 95% Confidence Interval P- Value Overall 19.5 -1.77* -1.94 to -1.68 < 0.000001 American Indian or Alaska Native 16.1 -0.93 -1.78 to 0.17 0.083583 Asian or Pacific Islander 8.4 -2.33* -2.79 to -1.9 < 0.000001 Black or African American 36 -2.60* -2.85 to -2.35 < 0.000001 White 18.6 -1.59* -1.75 to -1.51 < 0.000001 Hispanic or Latino 14.4 -1.85* -2.24 to -1.56 < 0.000001 Northeast 18.6 -2.17* -2.45 to -1.93 < 0.000001 Midwest 20 -1.80* -1.96 to -1.68 < 0.000001 South 19.2 -1.85* -1.93 to -1.77 < 0.000001 West 20.4 -1.64* -1.82 to -1.46 < 0.000001 Metro (Urban) 19.2 -1.79* -1.99 to-1.69 < 0.000001 Nonmetro (Rural) 21.2 -1.61* -1.87 to -1.43 < 0.000001