Long-term trends in the burden of prostate cancer in the United States from 1990 to 2021: A detailed analysis based on the Global Burden of Disease Study 2021

Prostate cancer (PCa) is a major public health challenge in the United States. This study analyzed the long-term trends in PCa burden from 1990 to 2021 and provides projections for future trends. Data were obtained from the Global Burden of Disease 2021 database to evaluate PCa burden metrics in the United States and globally, including incidence, prevalence, mortality, and disability-adjusted life years. Temporal trends were assessed using joinpoint regression analysis, while age-period-cohort models were applied to evaluate the effects of age, period, and birth cohort. Decomposition analysis was performed to quantify the contributions of population growth, population aging, and epidemiological changes to variations in PCa burden. Future trends through 2036 were projected using a Bayesian age-period-cohort model. Relative to global estimates, the burden of PCa remained higher in the United States throughout the study period. In 2021, PCa imposed a significant burden on males in the United States, particularly among individuals aged 65 to 69. An estimated 2,671,779 prevalent cases, 297,836 incident cases, and 44,032 deaths were recorded. The age-standardized incidence rate and age-standardized prevalence rate in the United States exceeded the corresponding global estimates, reaching 108.04 and 967.87 per 100,000 population, respectively. Although age-standardized rates generally declined between 1990 and 2021, the absolute numbers of incident and prevalent cases continued to increase, indicating that an increasing number of individuals are living with PCa. Among U.S. states, Louisiana had the highest burden, whereas Hawaii had the lowest. Decomposition analysis revealed that population aging and population growth increased the burden of PCa, whereas epidemiological changes partially offset these increases. Projections suggested a gradual increase in the burden of PCa through 2036. These findings highlight the need for targeted public health strategies to reduce the future burden of PCa in the United States.