A Comparative Study of the Global Burden of Prostate Cancer (1990-2021): Emphasis on the Disparities Between the...

Prostate Cancer (PCa) is the second most common malignancy among men worldwide, with significant heterogeneity in disease burden across countries. The United States (US) and China, representing high socio-demographic index (SDI) countries and rapidly developing economies respectively, have distinct healthcare systems that lead to contrasting trends in PCa epidemiology. A systematic comparison of the PCa burden between the two nations from 1990 to 2021, based on the latest Global Burden of Disease (GBD) database 2021, remains limited.

Data on age-standardized incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASMR), and disability-adjusted life years (ASDR) of PCa were extracted from the GBD 2021 database. Joinpoint regression and estimated annual percent change (EAPC) analyses were performed to evaluate time trends. Das Gupta's decomposition method was used to quantify the relative contributions of population growth, aging and epidemiological changes on the PCa burden. Comparative analyses focused on age-specific differences between the US and China.

From 1990 to 2021, Global ASIR increased from 13.69 (12.96-14.19) to 15.37 (14.13-16.25) per 100,000; the US ASMR fell from 10.85 to 6.91 (EAPC - 1.83) while China's ASIR rose from 2.04 to 4.22 (EAPC + 2.20). The aging population accounts for 74.49% of new cases and 214.72% of cancer deaths in the US, compared to 46.62% of new cases and 79.02% of deaths in China. In the US, age-specific incidence rates offset 32.44% of new cases, while in China, 31,610 new cases-representing 42.23%-were attributed to age-specific rates. The divergent magnitude, age distribution, and trajectory of PCa burden between the two countries underscore the urgent need for country-specific strategies.

The PCa burden in the US and China has evolved in markedly different directions over the past three decades, reflecting profound impact in screening strategies and population aging. High SDI countries should refine risk-based screening protocols and management strategies. Meanwhile, China and other low and middle SDI countries must expand early, targeted screening for high-risk populations and strengthen primary healthcare to mitigate the growing burden.