Global, regional, and national burden of early-onset prostate cancer, 1990–2021: a systematic analysis for the global burden of disease study 2021

Early-onset prostate cancer (EOPC), commonly defined as prostate cancer diagnosed before age 55 years, may differ from later-onset disease in epidemiology and clinical impact. However, the global burden of EOPC among younger adults and its variation by socio-demographic development, including patterns during the COVID-19 period, remain incompletely characterized. Using the Global Burden of Disease 2021 dataset, we quantified the burden of EOPC among individuals aged 20–54 years from 1990 to 2021 at global, regional, and national levels. We evaluated incidence, mortality, disability-adjusted life years (DALYs), and corresponding age-standardized rates. Temporal trends were assessed using Joinpoint regression and summarized as average annual percent change. We decomposed changes in DALYs into contributions from population growth, population aging, and epidemiologic change. Health inequality was assessed across Socio-demographic Index (SDI) strata using inequality metrics. The COVID-19 period (2019–2021) was analyzed as a predefined subperiod. Future burden through 2045 was projected using the Nordpred model. Globally, incident EOPC cases and age-standardized incidence increased over 1990–2021, while age-standardized mortality and DALY rates declined. Burden patterns varied substantially by SDI, with an increasing relative concentration of DALYs in lower-SDI settings. Decomposition indicated that population growth and aging were major contributors to rising DALYs. During 2019–2021, the age-standardized incidence rate persisted in rising across middle, low-middle, and low SDI regions. Projections suggested a continued, moderate increase in EOPC burden through 2045. The global burden of EOPC is increasing, with widening disparities and a growing relative burden in lower-SDI settings. These findings support risk-stratified early evaluation and strengthening timely diagnosis and standardized care in resource-limited regions, alongside more equitable allocation of cancer control resources.