Alongside this rise, prostate cancer mortality rates—which had been declining for years—have now leveled off in most parts of the state. These findings highlight the ongoing challenge of balancing early detection with avoiding unnecessary treatments, a dilemma that continues to shape prostate cancer screening policies.

The study, published on January 27 in JAMA Network Open, emphasizes the importance of finding an effective screening strategy that detects life-threatening cancers while minimizing the diagnosis of non-aggressive tumors that may never pose a health risk.

A Statewide Concern Across All Demographics

“This overall rising trend is alarming and has occurred across age groups, regions of California, races, and ethnicities,” said Erin L. Van Blarigan, ScD, an associate professor of Epidemiology & Biostatistics and Urology at UCSF and the lead author of the study.

“Our data point to how urgent this problem is,” she added. “Figuring out the best way to screen for prostate cancer continues to be a challenge for researchers and doctors. Without screening, the number of men diagnosed with advanced prostate cancer – when treatments are less effective – increases fast.”

Balancing the Risks and Benefits of Prostate Cancer Screening

Prostate cancer is the most common cancer among men in the U.S. and the second-leading cause of cancer-related deaths. However, not all cases are the same—while some forms of the disease are aggressive and potentially fatal, many cases involve low-grade tumors that remain contained and never spread.

The most common screening method, prostate-specific antigen (PSA) testing, is widely used but comes with limitations. Since PSA tests cannot distinguish between aggressive and non-aggressive cancers, some men are diagnosed and treated for prostate cancer that would never have caused them harm. This can lead to unnecessary procedures, including surgeries that come with risks like incontinence and sexual dysfunction.

On the other hand, forgoing screenings entirely means that some aggressive cancers may go undetected until they reach advanced stages, when treatment options become less effective.

For years, doctors routinely screened all men for prostate cancer. However, in 2012, the U.S. Preventative Services Task Force (USPSTF) recommended that routine PSA testing should no longer be performed for all men to reduce unnecessary medical interventions. By 2018, guidelines were updated again, suggesting that men ages 55-69 should discuss screening options with their doctor to weigh the potential benefits and risks.

Despite these updated recommendations, not all men are having these conversations with their physicians, raising concerns that some individuals at higher risk may be missing the opportunity for early detection.

Prostate Cancer Cases and Death Rates in California

The UCSF study examined data from nearly 388,000 men diagnosed with prostate cancer in California between 2004 and 2021. Of these cases, almost 28,000 men (7.2%) had been diagnosed with advanced-stage prostate cancer, a form of the disease with a five-year survival rate of just 37%.

Researchers also looked at prostate cancer mortality trends over the same period and found that, after years of decline, death rates have stopped decreasing in many parts of California.

Key findings from the study include:

• Advanced prostate cancer rates remained stable or declined until 2010, but then began rising at a rate of 6.7% per year from 2011 to 2021.
• Nationally, cases rose by 4.5% per year between 2011 and 2019, making California’s increase significantly higher than the U.S. average.
• Some regions in California saw faster increases than others—the lowest annual growth was in the Southern San Joaquin Valley (2.3%), while the highest increase was in the Central Coast (9.1%).
• Prostate cancer deaths declined by 2.6% per year from 2004 to 2012 but then plateaued in 7 out of 10 regions in the state.
• Mortality rates were highest in the Inland Empire, followed by San Diego-Imperial and the North Coast, while the lowest mortality rates were found in the San Francisco Bay Area.

These findings suggest that regional differences in healthcare access, screening awareness, and lifestyle factors may influence cancer detection and outcomes.

The Importance of Ongoing Monitoring and Research

As scientists continue to examine prostate cancer trends, keeping a close eye on how screening guidelines affect different populations is critical.

“It’s important to continue monitoring prostate cancer trends both in California and nationally as we learn more about the impact of screening guidelines on different populations,” said Scarlett L. Gomez, PhD, MPH, a senior author of the study and a professor in the UCSF Department of Epidemiology & Biostatistics.

Going forward, researchers and healthcare providers will need to find a balance between early detection and reducing unnecessary treatments. Emerging advancements in genetic testing, biomarker analysis, and imaging technologies may help doctors better identify high-risk patients who would benefit most from screening while avoiding overdiagnosis in low-risk individuals.

Looking Ahead: What This Means for Men’s Health

Prostate cancer remains a major health concern, and the findings from this study highlight the need for continued awareness, research, and patient education. While the debate over screening guidelines continues, one thing is clear—early detection remains key for those at high risk.

Men should have open discussions with their doctors about the benefits and risks of screening, particularly if they have a family history of prostate cancer or belong to high-risk groups.

As research progresses, medical professionals hope to develop better screening methods that can distinguish between aggressive and non-aggressive cancers, ensuring that those who need treatment receive it while others avoid unnecessary medical interventions.

The study was published in JAMA Network Open under the title “Trends in Prostate Cancer Incidence and Mortality Rates” and funded by the California Department of Public Health, Centers for Disease Control and Prevention’s National Program of Cancer Registries, and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program.

Animal rights activists and advocates believe the proposed Pet Rescue and Adoption Act (AB 485) would effectively end the use of breeding operations — termed “puppy mills” (or other species), these massive operations churn out a constant stream of puppies, kittens, and other companion animals, often in abominable, abusive, or neglected conditions — and aspire to choke out retailers who insist on sourcing animals that way.

Legitimate criticism certainly exists in the law’s inherent elimination of choice from the marketplace, as far as the retail pursuit of specific pet breeds is concerned, with detractors pegging a dearth of reliable genetic and medical information available for individual shelter animals, as well as the fact many popular breeds never wind up housed in such facilities.

Proponents rightly point to abandoned and unwanted animals, as the United States continues grappling with an astronomical explosion in feral and stray populations — which the American Society for the Prevention of Cruelty to Animals reports ‘forced’ the euthanization of at least 1.5 million unadopted shelter companion animals — in just 2016, alone.

“California taxpayers spend over a quarter of a billion dollars every year to house homeless animals,” San Diego Humane Society CEO and President Dr. Gary Weitzman told Huffington Post in an emailed ASPCA statement pertaining to the new bill, adding the strongest potential lies in the elimination of “a main source of sales for inhumane commercial breeders.”

In fact, as the San Diego Tribune points out, well over 200 areas around the U.S. have implemented policies like the California legislation, and have indeed severely crippled pet breeding operations to the betterment of strays and mill animals, alike, over the past decade, and reports,

“California has more than 33 cities with these ordinances, from South Lake Tahoe in 2009 to Oceanside in 2015, to Los Angeles in 2016, to San Francisco and Sacramento this year.

“Most of these rules allow storefronts to sell animals acquired from shelters, rescue groups and nonprofits. In practice, many of the targeted pet-store merchants have gone out of business or been forced to move locations.

“Supporters said the bans are a local reaction to breeders, mostly located in the Midwest, who warehouse dogs and cats like livestock. They said too often, animals, especially breeding mothers, are locked in unsanitary and inhumane conditions without proper access to medicine, exercise and contact with people.”

And HuffPost expounds, “One of the most comprehensive of those measures was passed in Cambridge, Massachusetts, in August. Cambridge’s ordinance bans pet stores from selling any non-rescue animals other than fish — meaning that besides dogs and cats, it also covers everything from birds to snakes to small animals like mice, rats and hamsters.”

Advocates reiterate the measure only affects retail sales of pets, and anyone searching for a specific breed would be free to contact an ethical breeder privately — an obstacle critics feel places too many barriers between customer and product, thus threatening to erase the market of many popular breeds never making it to shelters.

“Pet stores represent a well-regulated and reliable source for responsibly raised animals, often breeds which are not readily available nearby,” Mike Bober, president and CEO of the Pet Industry Joint Advisory Council, told HuffPost. “We do think that consumer choice is an important part of this.”

Although Bober’s latter point is again valid, the idea problematic breeding farms are the rarity rather than the rule is preposterous when examined in the context of an unending list of horrendous animal abusers calling themselves reputable to reap profit, supply the vast majority of pet stores — from the little guy to corporate behemoths.

Paul Solotaroff toured an illegal puppy mill as part of an investigation into such facilities for Rolling Stone in January 2017, observing,

“Out the back door and up a dirt trail, the worst was yet to come. A cinder-block kennel, hidden from the street, housed the bulk of this puppy-mill stock: 50 or 60 more parent dogs who’d likely never seen sunlight or spent a day outside this toxic room. They wept and bayed and spun in crazed circles as we toured the maze of cages. Some went limp as the rescuers knelt to scoop them. Each was photographed, then carried downhill to the giant rig at the curb. There, teams of vets from the Cabarrus Animal Hospital worked briskly to assess each rescue. Once triaged and tagged, they were loaded into crates on the Humane Society’s mammoth truck, an 80-foot land-ship with clean-room conditions, and taken to a staging shelter. One hundred and five dogs came out of that house, many of them pregnant or in heat. I turned to John Goodwin, the director of the puppy-mills campaign for HSUS, and asked him how many puppies sold in this country — at Petland and Citipups and a thousand other pet stores — come from puppy mills as dire as this one.”

Emaciated animals, deplorably filthy conditions, disease, parasites, and other issues plague the animal prisoners of breeding-mill hell — and with profit potential tantalizingly large, violation of regulations and animal rights comprise a risk worth taking for the unscrupulous, to the detriment of the pets.

“Most every pup sold in stores in America comes from this kind of suffering — or worse,” Goodwin insisted. “If you buy a puppy from a pet store, this is what you’re paying for and nothing else: a dog raised in puppy-mill evil.”

Matt Bershadker, president and CEO of the ASPCA, added, “Puppy mills house breeding dogs in small, wire-floored cages, separate puppies from their mothers at a very young age, and ship them hundreds of miles to pet stores around the country.”

While the proposed legislation in California might not be ideal, it could save state residents a small fortune, as the San Diego Tribune notes, since “it costs taxpayers an estimated $250 million each year to pick up, house and often euthanize unwanted animals, including more than 800,000 dogs, cats and rabbits, according to the same legislative analysis.”

To begin thwarting the animal abusers on an individual level, the ASPCA maintains a mapped and updated list of puppy mills and pointers for animal advocates on their website, in this link.

Governor Brown has until October 15 to sign the bill into law, but — as to his intentions — remained tight-lipped when the Associated Press requested comment.

(Image: Puppy Mill. Credit: ASPCA)