Prostate cancer worldwide: updated epidemiology, disparities, and screening implications

Prostate cancer epidemiology is evolving because of three simultaneous factors: a rising global burden, population aging, and renewed debate about how early detection can reduce advanced disease without returning to non-risk-adapted PSA testing. This Review provides an updated overview of prostate cancer incidence, mortality, prevalence, risk factors, disparities, and screening implications.

We synthesized recent systematic reviews, meta-analyses, randomized screening trials, and population-based registry data, supplemented by landmark historical studies.

Current trends cannot be interpreted without accounting for screening policy, diagnostic intensity, access to MRI and biomarkers, inherited susceptibility, and health-system capacity. Age, family history, ancestry, and germline risk remain the strongest determinants. Most modifiable exposures are weaker and inconsistent, and are better framed within cardiometabolic health and survivorship care. Organized, risk-adapted pathways integrating PSA, MRI, biomarkers, and baseline risk may better preserve early-detection benefits while reducing overdiagnosis and inequity.

Progress will depend on preventing metastatic disease, minimizing overtreatment, and implementing modern diagnostics equitably.