Trends in prostate cancer in the United States.

In the United States, prostate cancer is the most commonly diagnosed non-skin cancer and the second leading cause of cancer death. The American Cancer Society estimates that 241 740 American men will be diagnosed with the disease and 28 170 men will die of it in 2012. Prostate cancer demographics have changed dramatically over the past 30 years. The prostate cancer age-adjusted incidence rate increased through the 1980s and peaked in the early to mid-1990s. The incidence rate has declined since. American mortality rates rose through the 1980s and peaked in 1991. Today, the American incidence rates are below 1975 levels. Both the incidence rate and the 5-year survival rates are heavily influenced by the introduction of serum prostate-specific antigen test and the widespread use of it in cancer screening. The effect of screening on prostate cancer mortality is less certain. Screening has caused a dramatic increase in the number and proportion of men diagnosed with localized disease. Outcomes studies among men treated with radical prostatectomy show that greater than 30% serum prostate-specific antigen relapse rates are common. This suggests that many men who are diagnosed with "localized early stage disease" actually have "apparently localized early stage disease," which is really low-volume metastatic disease.