Prostate Cancer Incidence and Survival, by Stage and Race/Ethnicity — United States, 2001–2017

Abstract

Among U.S. men, prostate cancer is the second leading cause of cancer-related death ( 1 ). Past studies documented decreasing incidence of prostate cancer overall since 2000 but increasing incidence of distant stage prostate cancer (i.e., signifying spread to parts of the body remote from the primary tumor) starting in 2010 ( 2 , 3 ). Past studies described disparities in prostate cancer survival by stage, age, and race/ethnicity using data covering ≤80% of the U.S. population ( 4 , 5 ). To provide recent data on incidence and survival of prostate cancer in the United States, CDC analyzed data from population-based cancer registries that contribute to U.S. Cancer Statistics (USCS).* Among 3.1 million new cases of prostate cancer recorded during 2003–2017, localized, regional, distant, and unknown stage prostate cancer accounted for 77%, 11%, 5%, and 7% of cases, respectively, but the incidence of distant stage prostate cancer significantly increased during 2010–2017. During 2001–2016, 10-year relative survival for localized stage prostate cancer was 100%. Overall, 5-year survival for distant stage prostate cancer improved from 28.7% during 2001–2005 to 32.3% during 2011–2016; for the period 2001–2016, 5-year survival was highest among Asian/Pacific Islanders (API) (42.0%), followed by Hispanics (37.2%), American Indian/Alaska Natives (AI/AN) (32.2%), Black men (31.6%), and White men (29.1%). Understanding incidence and survival differences by stage, race/ethnicity, and age can guide public health planning related to screening, treatment, and survivor care. Future research into differences by stage, race/ethnicity, and age could inform interventions aimed at improving disparities in outcomes. Cases included males with malignant † prostate cancer § and excluded cases diagnosed by autopsy and death certificate only. Incidence data were from USCS during the period 2003–2017 and covered 100% of the U.S. population. Age-adjusted rates were expressed per 100,000 men. ¶ Trends in incidence were described using annual percent change (APC) and average annual percent change (AAPC) calculated by joinpoint regression. Statistically significant APC and AAPC were different from zero (p<0.05).** Survival data were from CDC’s National Program of Cancer Registries (NPCR)–funded registries that conducted active case follow-up or linkage with CDC’s National Death Index, and covered 94% of the U.S. population. †† Survival analysis included cases diagnosed during 2001–2016 with follow-up through December 31, 2016. Relative survival (cancer survival in the absence of other causes of death) was calculated §§ for 1, 5, and 10 years after diagnosis, using expected life tables stratified by age, sex, race/ethnicity, socioeconomic status, geographic location, and calendar year of diagnosis. ¶¶ Differences between relative survival estimates were determined by comparing 95% confidence intervals (CIs), which allowed for an informal, conservative comparison of estimates. Differences in relative survival were noted when CIs did not overlap. Incidence and survival were stratified by stage, age, year of diagnosis, and race/ethnicity. There were four categories for race (Black, White, AI/AN, and API) and one for ethnicity (Hispanic). Men categorized by race were all non-Hispanic. Men categorized as Hispanic might be of any race. Stage was defined using Summary Stage, the staging system used by the cancer surveillance community and defined with the following categories: localized (tumor is confined to the organ of origin without extension beyond the primary organ), regional (direct extension of the tumor to adjacent organs or structures or spread to regional lymph nodes), distant (cancer has spread to parts of the body remote from the primary tumor), and unknown.*** During 2003–2017, a total of 3,087,800 new cases of prostate cancer were diagnosed in the United States (Table 1). Over this 15-year period, age-adjusted incidence decreased from 155 per 100,000 in 2003 to 105 in 2017 (Supplementary Table 1, https://stacks.cdc.gov/view/cdc/94592). During 2003–2017, incidence was highest for men aged 70–74 years (764) and Black men (202). Localized, regional, distant, and unknown stage prostate cancer accounted for 77%, 11%, 5%, and 7% of total cases, respectively. The percentage of localized cases decreased from 78% in 2003 to 70% in 2017, and distant cases increased from 4% in 2003 to 8% in 2017. White men had lower percentages of distant (5%) and unknown stage (6%) prostate cancer than did any other race/ethnicity. The overall incidence of prostate cancer decreased during 2003–2017 (AAPC = −2.5%) but increased for cases diagnosed at distant stage (AAPC = 2.2%). More specifically, the increase was observed during 2010–2017 (APC = 5.1%) and began in 2011 or earlier, regardless of race/ethnicity. During 2001–2016, among 3,104,380 men with survival data, 5-year and 10-year relative survival was 97.6% and 97.2%, respectively (Table 2). Men aged ≤49 years and ≥80 years had the lowest 10-year relative survival (95.6% and 82.7%, respectively). For localized prostate cancer, 10-year relative survival was 100%. Ten-year relative survival for regional, distant, and unknown stage was 96.1%, 18.5%, and 78.1%, respectively. For distant stage prostate cancer, 10-year relative survival was highest for ages 60–64 years (21.8%) and was <20% for ages <55 and ≥70 years. Comparing 2001–2005 with 2011–2016, 5-year relative survival improved from 97.5% to 99.3% for regional stage and from 28.7% to 32.3% for distant stage prostate cancer (Table 3). During 2001–2016, 5-year survival for distant stage prostate cancer was highest among API (42.0%), followed by Hispanics (37.2%), AI/AN (32.2%), Black men (31.6%), and White men (29.1%). Survival by race/ethnicity showed differences by age (Supplementary Table 2, https://stacks.cdc.gov/view/cdc/94593). For unknown stage prostate cancer, 5-year survival was higher for Hispanic (84.4%) and White men (82.8%) than Black men (79.1%). Discussion Although approximately three fourths of U.S. men with prostate cancer have localized stage at diagnosis, an increasing number and percentage of men have received diagnoses of distant stage prostate cancer. Survival with distant stage prostate cancer has improved, but fewer than one third of men survive 5 years after diagnosis. Survival disparities by age and race/ethnicity were noted for distant stage prostate cancer during all three periods (i.e., 2001–2005, 2006–2010, and 2011–2016) studied. The U.S. Preventive Services Task Force (USPSTF) has issued several recommendations that discuss the possible benefits and harms of screening for prostate cancer using prostate-specific antigen (PSA). ††† In 2012, USPSTF concluded that the benefits of PSA-based screening do not outweigh the harms and recommended against PSA-based screening for prostate cancer for men of all ages. This recommendation likely contributed to a decrease in overall reported prostate cancer incidence and might have contributed to an increase in the percentage and incidence of distant stage prostate cancer ( 2 , 3 ). Despite decreasing incidence of localized stage prostate cancer, 130,658 to 190,570 new cases were diagnosed each year in the United States during 2003–2017. Even though 10-year survival for localized stage prostate cancer is 100%, many of these patients need treatment, including surgery or radiation, often face long-term effects of their treatment (e.g., urinary incontinence and erectile dysfunction), and ≤6% progress to metastatic prostate cancer ( 6 ). Improvements in survival for distant stage prostate cancer might reflect changes in clinical management, which includes increased use of new agents and treatment innovations, such as new hormone and antibody therapies ( 6 ). Despite these improvements in survival, increases in distant stage prostate cancer incidence might have contributed to the plateauing of previously declining prostate cancer mortality during 2013–2017 ( 1 , 2 ). Five-year survival for all stages combined was higher for White men than Black or Hispanic men. However, survival for distant stage prostate cancer was higher for Black than White men, which is different from a past study reporting higher survival for White men than Black men during 2001–2009, but with overlapping 95% CIs ( 4 ). In addition, unknown stage prostate cancer represented a higher percentage of total cases (7%) than distant stage prostate cancer (5%), and survival for unknown stage prostate cancer was higher for Hispanic and White men than Black men. Men in the unknown stage category, who had a 5-year relative survival of 84.3%, might include a mixture of situations, such as men not healthy enough for a staging workup, situations where staging is not needed to guide treatment decisions, lack of access to care, or incomplete recording in the medical record ( 7 ). Past data suggest that social inequities by race contribute to worse outcomes for Black men than White men with prostate cancer ( 8 ). Survival based on distant stage and race/ethnicity might need to be interpreted in the context of the incidence and survival for other prostate cancer stages, as well as diagnostic procedures and social determinants of health such as access to care ( 7 , 8 ). Although survival by age varied by stage, survival was lowest for ages >75 years for regional, distant, and unknown stage prostate cancer. Lower survival for distant stage at age >75 years compared with younger ages might be secondary to more rapid development of resistant prostate cancer, reduced ability to receive available therapies, and impact of comorbidities ( 5 ). Ten-year survival was lower for men aged ≤49 years compared with all ages except ≥80 years. Prostate cancer incidence in men ≤49 years has risen over the past 3 decades, and lower survival for this age group has been reported ( 9 ). Prostate cancer behavior, genetics, family history, and treatment patterns might affect prostate cancer incidence and survival patterns for men aged ≤49 years ( 9 ). The findings in this report are subject to least three limitations. First, prostate cancer cases missing from the dataset could result in an undercount of prostate cancer incidence, §§§ and delays in reporting could undercount incidence over the most recent years of the study ( 10 ). Second, Collaborative Cancer Staging coding, which was used from 2003 to 2015 to code stage data, might explain the lower numbers of unknown stage cases during those years. ¶¶¶ Finally, confidence intervals could not be generated for all survival results that are rounded to 100.0%, and values listed as 100.0% only mean that no excess deaths were observed. In 2018, USPSTF issued a new recommendation stating that prostate cancer screening for men aged 55–69 years should be an individualized decision based on personal preferences when weighing the benefits and harms of screening,**** and several professional organizations have similarly recommended shared decision-making for men deciding about prostate cancer screening.†††† Understanding incidence and long-term survival by stage, race/ethnicity, and age could inform messaging related to the possible benefits and harms of prostate cancer screening and could guide public health planning related to treatment and survivor care. Further research is needed to examine how social determinants of health affect prostate cancer diagnosis and treatment; findings should inform interventions to decrease disparities in outcomes. Summary What is already known about this topic? Among U.S. men, prostate cancer is the second leading cause of cancer-related death. The incidence of distant stage prostate cancer (signifying spread to parts of the body remote from the primary tumor) has increased since 2010. What is added by this report? Additional years of data show continued increases in the incidence of distant stage prostate cancer in the United States. The percentage of distant stage prostate cancer increased from 4% in 2003 to 8% in 2017. Five-year survival for distant stage prostate cancer improved from 28.7% during 2001–2005 to 32.3% during 2011–2016; for the period 2001–2016, 5-year survival was highest among Asian/Pacific Islanders (42.0%), followed by Hispanics (37.2%), American Indian/Alaska Natives (32.2%), Black men (31.6%), and White men (29.1%). What are the implications for public health? Understanding the disease trends of distant stage prostate cancer and disparities in prostate cancer survival by stage, race/ethnicity, and age can guide public health planning related to screening, treatment, and survivor care. TABLE 1 Age-adjusted incidence* of prostate cancer† and annual percent change (APC) and average APC (AAPC) in rates per 100,000 men, by selected characteristics — U.S. Cancer Statistics, United States, 2003–2017 Characteristic No., % of total, and rate AAPC 2003–2017§ APC§ No. (%)¶ Rate (95%CI) AAPC (95% CI) Yrs APC1 (95% CI) Yrs APC2 (95% CI) Yrs APC3 (95% CI) Overall 3,087,800 (100) 128.4 (128.2 to 128.5) −2.5 (−4.1 to −0.9)** 2003–2007 2.0 (−1.6 to 5.7) 2007–2014 -6.6 (−8.8 to −4.4)** 2014–2017 1.6 (−4.0 to 7.6) Age group (yrs) ≤49 81,420 (3) 5.2 (5.1 to 5.2) −2.9 (−4.0 to −1.7)** 2003–2009 4.4 (2.2 to 6.6)** 2009–2017 −8.0 (−9.5 to −6.4)** —†† — 50–54 212,288 (7) 134.5 (133.9 to 135.0) −1.6 (−3.7 to 0.6) 2003–2009 2.7 (0.2 to 5.2)** 2009–2014 −7.4 (−11.7 to −2.8)** 2014–2017 −0.1 (−7.8 to 8.3) 55–59 410,683 (13) 288.0 (287.1 to 288.9) −1.8 (−3.6 to 0.0) 2003–2008 2.3 (−0.7 to 5.4) 2008–2014 −6.4 (−9.2 to −3.6)** 2014–2017 1.1 (−5.7 to 8.3) 60–64 569,259 (18) 484.7 (483.4 to 485.9) −1.9 (−3.7 to −0.1)** 2003–2008 1.9 (−1.1 to 5.0) 2008–2014 −6.9 (−9.6 to −4.1)** 2014–2017 2.2 (−4.4 to 9.2) 65–69 658,449 (21) 720.0 (718.3 to 721.8) −2.0 (−3.8 to −0.1)** 2003–2008 1.4 (−1.8 to 4.8) 2008–2014 −6.8 (−9.8 to −3.8)** 2014–2017 2.5 (−4.3 to 9.8) 70–74 516,620 (17) 764.0 (762.0 to 766.1) −2.5 (−4.4 to −0.6)** 2003–2007 2.0 (−2.4 to 6.5) 2007–2014 −7.0 (−9.2 to −4.6)** 2014–2017 2.3 (−4.8 to 9.9) 75–79 346,422 (11) 693.6 (691.3 to 695.9) −3.1 (−4.9 to −1.3)** 2003–2007 0.6 (−3.1 to 4.5) 2007–2014 −8.0 (−10.2 to −5.9)** 2014–2017 4.1 (−3.1 to 11.7) ≥80 292,659(9) 473.1 (471.4 to 474.8) −4.6 (−5.9 to −3.2)** 2003–2007 −2.7 (−5.7 to 0.4) 2007–2013 −9.5 (−11.7 to −7.2)** 2013–2017 1.4 (−2.4 to 5.2) Race/Ethnicity§§ White 2,296,805 (74) 122.2 (122.0 to 122.3) −2.7 (−4.7 to −0.5)** 2003–2007 2.1 (−2.5 to 7.0) 2007–2014 −7.0 (−9.4 to −4.6)** 2014–2017 1.6 (−6.7 to 10.7) Black 451,822 (15) 202.3 (201.7 to 203.0) −2.6 (−3.9 to −1.2)** 2003–2009 −0.5 (−2.2 to 1.1) 2009–2014 −6.6 (−9.5 to −3.7)** 2014–2017 0.4 (−4.3 to 5.3) AI/AN 12,232 (0) 87.9 (86.2 to 89.6) −3.4 (−5.3 to −1.4)** 2003–2009 −0.6 (−3.1 to 1.8) 2009–2014 −7.9 (−11.8 to −3.8)** 2014–2017 −1.1 (−7.7 to 6.0) API 62,184 (2) 67.2 (66.6 to 67.7) −3.6 (−6.5 to −0.6)** 2003–2011 −3.3 (−4.8 to −1.7)** 2011–2014 −11.1 (−23.5 to 3.3) 2014–2017 3.6 (−3.1 to 10.8) Hispanic 196,506 (6) 106.0 (105.5 to 106.5) −3.8 (−4.9 to −2.6)** 2003–2008 −0.5 (−2.5 to 1.5) 2008–2014 −7.4 (−9.1 to −5.7)** 2014–2017 −1.5 (−5.7 to 2.9) Stage¶¶ Localized 2,373,517 (77) 98.1 (98.0 to 98.3) −3.3 (−5.1 to −1.4)** 2003–2007 3.1 (−1.2 to 7.5) 2007–2014 −8.0 (−10.1 to −5.9)** 2014–2017 −0.1 (−7.2 to 7.5) Regional 344,750 (11) 13.5 (13.4 to 13.5) 0.2 (−1.5 to 2.1) 2003–2007 3.3 (−0.9 to 7.7) 2007–2013 −3.2 (−6.1 to −0.2)** 2013–2017 2.5 (−1.9 to 7.2) Distant 157,175 (5) 7.2 (7.1 to 7.2) 2.2 (1.7 to 2.7)** 2003–2010 −0.7 (−1.5 to 0.2) 2010–2017 5.1 (4.3 to 5.8)** — — Unknown 212,358 (7) 9.6 (9.6 to 9.7) −2.8 (−5.3 to −0.2)** 2003–2005 −16.5 (−26.3 to −5.4)** 2005–2015 −3.8 (−5.4 to −2.1)** 2015–2017 19.1 (1.2 to 40.1)** Stage by race/ethnicity Localized White 1,782,452 (78) 94.5 (94.3 to 94.6) −3.4 (−5.3 to −1.4)** 2003–2007 3.1 (−1.3 to 7.8) 2007–2014 −8.4 (−10.7 to −6.1)** 2014–2017 0.5 (−7.1 to 8.7) Black 349,321 (77) 153.8 (153.3 to 154.3) −2.9 (−4.4 to −1.5)** 2003–2008 1.5 (−1.0 to 4.0) 2008–2014 −7.0 (−9.2 to −4.8)** 2014–2017 −1.7 (−7.0 to 3.9) AI/AN 8,818 (72) 61.8 (60.4 to 63.2) −3.9 (−6.2– to −1.6)** 2003–2008 1.1 (−3.0 to 5.3) 2008–2014 −9.0 (−12.5 to −5.3)** 2014–2017 −1.6 (−9.8 to 7.4) API 45,682 (73) 48.9 (48.5 to 49.4) −4.7 (−7.5 to −1.9)** 2003–2007 −0.4 (−7.4 to 7.1) 2007–2014 −8.9 (−12.2 to −5.5)** 2014–2017 −0.2 (−10.2 to 10.9) Hispanic 143,627 (73) 76.3 (75.8 to 76.7) −4.7 (−5.9 to −3.6)** 2003–2008 0.0 (−2.0 to 2.1) 2008–2014 −8.8 (−10.6 to −7.1)** 2014–2017 −4.1 (−8.4 to 0.4) Regional White 267,155 (12) 13.5 (13.5 to 13.6) 0.5 (−1.5 to 2.5) 2003–2007 4.1 (−0.6 to 9.0) 2007–2013 −3.3 (−6.5 to −0.1)** 2013–2017 2.8 (−2.1 to 7.9) Black 43,672 (10) 17.5 (17.3 to 17.6) −0.1 (−2.1 to 2.0) 2003–2010 0.1 (−1.6 to 1.8) 2010–2013 −4.7 (−14.0 to 5.5) 2013–2017 3.3 (0.0 to 6.6)** AI/AN 1,412 (12) 8.7 (8.2 to 9.2) −0.7 (−2.1 to 0.7) API 8,014 (13) 7.8 (7.6 to 8.0) 0.9 (−2.2 to 4.0) 2003–2011 1.1 (−1.0 to 3.1) 2011–2014 −8.1 (−20.8 to 6.7) 2014–2017 10.1 (2.8 to 17.9)** Hispanic 21,853 (11) 10.3 (10.2 to 10.5) −1.4 (−2.0 to −0.9)** 2003–2017 −1.4 (−2.0 to −0.9)** — — Distant White 110,453 (5) 6.4 (6.3 to 6.4) 2.7 (2.1 to 3.2)** 2003–2010 −0.2 (−1.1 to 0.8) 2010–2017 5.6 (4.8 to 6.4)** — — Black 28,946 (6) 15.1 (14.9 to 15.2) 0.1 (−0.6 to 0.8) 2003–2011 −2.4 (−3.4 to −1.3)** 2011–2017 3.5 (2.2 to 4.8)** — — AI/AN 911 (7) 7.7 (7.1 to 8.2) 2.2 (0.8 to 3.6)** — API 3,867 (6) 4.7 (4.6 to 4.9) 1.7 (−0.5 to 4.0) 2003–2006 3.7 (−4.4 to 12.5) 2006–2010 −5.0 (−10.8 to 1.1) 2010–2017 4.9 (3.3 to 6.6)** Hispanic 12,275 (6) 7.5 (7.4 to 7.6) 0.5 (−0.3 to 1.3) 2003–2011 −1.6 (−2.9 to −0.4)** 2011–2017 3.4 (2.0 to 4.8)** — Unknown White 136,745 (6) 7.8 (7.8 to 7.9) −6.1 (−9.0 to −3.1)** 2003–2005 −19.2 (−35.1 to 0.7) 2005–2017 −3.8 (−5.7 to −1.8)** — — Black 29,883 (7) 16.0 (15.8 to 16.2) −4.2 (−5.7 to −2.7)** — — — — — — AI/AN 1,091 (9) 9.8 (9.2 to 10.4) −6.0 (−8.4 to −3.5)** — — — — — — API 4,621 (7) 5.7 (5.5 to 5.8) −2.0 (−3.7 to −0.2)** — — — — — — Hispanic 18,751 (10) 11.9 (11.7 to 12.1) −4.2 (−6.1 to −2.2)** — — — — — — Abbreviations: AI/AN = American Indian/Alaska Native; API = Asian/Pacific Islander; CI = confidence interval. * Incidence data are compiled from cancer registries that meet the U.S. Cancer Statistics publication criteria for the period 2003–2017 (covering 100% of the U.S. population). Characteristic values with other, missing, or blank results are not included. Rates are age-adjusted to the 2000 U.S. Standard population. † Cases included International Classification of Diseases for Oncology, Third Edition malignant cancers only. § Trends were considered to increase or decrease if p<0.05; otherwise trends were considered stable. ¶ Denominator for this column is 3,087,800, except for stage by race/ethnicity, where the denominator is the total number of cases for the respective race/ethnicity grouping. ** p<0.05. †† Trend described for the period 2003–2017 by previous APC columns. §§ White, Black, AI/AN, and API men are non-Hispanic. Hispanic men might be of any race. Counts exclude unspecified or unknown race/ethnicity. Excludes 67,696 cases with non-Hispanic unknown race. ¶¶ Defined by merged Summary Stage. https://www.cdc.gov/cancer/uscs/public-use/dictionary/merged-summary-stage.htm. TABLE 2 Relative survival of men with prostate cancer, 1, 5, and 10 years after diagnosis — United States, 2001–2016* Characteristic No. 1-year relative survival % (95% CI) 5-year relative survival % (95% CI) 10-year relative survival % (95% CI) Overall 3,104,380 99.0 (98.9–99.0) 97.6 (97.5–97.6) 97.2 (97.2–97.3) Age group (yrs) ≤49 83,692 99.3 (99.2–99.3) 96.7 (96.6–96.7) 95.6 (95.6–95.9) 50–54 214,757 99.6 (99.5–99.6) 97.8 (97.6–97.8) 96.9 (96.9–97.1) 55–59 407,302 99.7 (99.6–99.7) 98.4 (98.3–98.4) 98.0 (98.0–98.1) 60–64 559,872 99.7 (99.7–99.7) 98.8 (98.8–98.8) 98.7 (98.7–98.9) 65–69 650,004 99.9 (99.9–99.9) 99.6 (99.5–99.6) 99.5 (99.5–99.7) 70–74 525,876 99.8 (99.8–99.8) 99.5 (99.4–99.5) 99.4 (99.4–99.6) 75–79 361,735 99.1 (99.0–99.1) 98.4 (98.2–98.4) 97.9 (97.9–98.3) ≥80 301,315 92.1 (92.0–92.1) 84.6 (84.2–84.6) 82.7 (82.7–83.5) Race/Ethnicity† White 2,323,828 99.1 (99.0–99.1) 97.9 (97.9–97.9) 97.8 (97.8–97.9) Black 459,665 98.4 (98.4–98.4) 95.6 (95.4–95.6) 93.5 (93.5–93.8) AI/AN 11,983 98.2 (97.7–98.2) 95.7 (94.7–95.7) 93.4 (93.4–95.0) API 55,310 98.7 (98.6–98.7) 95.1 (94.8–95.1) 92.0 (92.0–92.6) Hispanic 193,770 98.4 (98.3–98.4) 95.3 (95.1–95.3) 93.1 (93.1–93.4) Stage§ Localized 2,393,365 100.0¶ 100.0 100.0 Regional 328,421 100.0 (100.0–100.0) 98.6 (98.5–98.6) 96.1 (96.1–96.4) Distant 145,923 75.6 (75.3–75.6) 30.7 (30.4–30.7) 18.5 (18.5–18.9) Unknown 236,919 93.2 (93.1–93.2) 84.3 (84.0–84.3) 78.1 (78.1–78.5) Stage by age group (yrs) Localized ≤49 65,134 100.0 (99.8–100.0) 99.9 (99.7–99.9) 99.8 (99.8–99.9) 50–54 167,635 100.0 100.0 100.0 55–59 318,323 100.0 100.0 100.0 60–64 437,309 100.0 100.0 100.0 65–69 512,706 100.0 100.0 100.0 70–74 421,401 100.0 100.0 100.0 75–79 283,797 100.0 100.0 100.0 ≥80 187,081 100.0 (99.9–100.0) 100.0 (99.9–100.0) 100.0 (100.0–100.0) Regional ≤49 12,140 99.8 (99.6–99.8) 97.0 (96.5–97.0) 92.6 (92.6–93.4) 50–54 32,016 100.0 97.9 (97.6–97.9) 94.1 (94.1–94.6) 55–59 58,398 100.0 99.0 (98.7–99.0) 95.9 (95.9–96.4) 60–64 76,162 100.0 100.0 (91.2–100.0) 97.8 (97.8–98.2) 65–69 77,433 100.0 100.0 99.9 (99.9–100.0) 70–74 42,562 100.0 100.0 99.6 (99.6–100.0) 75–79 17,034 99.3 (98.8–99.3) 94.2 (93.1–94.2) 90.4 (90.4–92.3) ≥80 12,678 90.7 (89.9–90.7) 70.8 (69.0–70.8) 64.4 (64.4–67.3) Distant ≤49 3,083 84.9 (83.6–84.9) 31.1 (29.2–31.1) 19.0 (19.0–20.9) 50–54 6,488 85.4 (84.5–85.4) 32.7 (31.3–32.7) 19.1 (19.1–20.5) 55–59 12,607 84.3 (83.6–84.3) 35.5 (34.5–35.5) 20.8 (20.8–21.9) 60–64 18,268 83.2 (82.6–83.2) 35.1 (34.2–35.1) 21.8 (21.8–22.8) 65–69 21,311 82.4 (81.8–82.4) 36.2 (35.3–36.2) 21.2 (21.2–22.1) 70–74 21,066 77.9 (77.3–77.9) 33.3 (32.5–33.3) 19.8 (19.8–20.9) 75–79 21,299 73.4 (72.8–73.4) 29.9 (29.0–29.9) 18.5 (18.5–19.6) ≥80 41,810 63.3 (62.8–63.3) 22.5 (21.8–22.5) 14.6 (14.6–15.8) Unknown ≤49 3,340 97.8 (97.2–97.8) 91.7 (90.5–91.7) 88.3 (88.3–89.8) 50–54 8,625 98.3 (98.0–98.3) 93.0 (92.2–93.0) 88.7 (88.7–89.8) 55–59 17,984 98.2 (97.9–98.2) 93.0 (92.4–93.0) 88.7 (88.7–89.5) 60–64 28,148 97.8 (97.5–97.8) 92.1 (91.6–92.1) 87.5 (87.5–88.3) 65–69 38,573 97.5 (97.3–97.5) 91.3 (90.8–91.3) 85.4 (85.4–86.2) 70–74 40,864 96.6 (96.3–96.6) 89.2 (88.6–89.2) 82.8 (82.8–83.8) 75–79 39,622 94.2 (93.9–94.2) 85.6 (84.9–85.6) 77.7 (77.7–79.0) ≥80 59,766 82.7 (82.3–82.7) 65.7 (64.9–65.7) 57.2 (57.2–58.7) Source: CDC’s National Program of Cancer Registries, https://www.cdc.gov/cancer/npcr. Abbreviations: AI/AN = American Indian/Alaska Native; API = Asian/Pacific Islander; CI = confidence interval. * Data were compiled from 45 population-based registries that cover approximately 94% of the US population. Counts for age and stage do not sum to the total because of multiple primaries methodology. When the relative survival is calculated stratified by a tumor or demographic characteristic, each cancer was included for patients diagnosed with multiple primary prostate cancers at the different category-levels. † White, Black, AI/AN, and API men are non-Hispanic. Hispanic men might be of any race. Counts exclude unspecified or unknown race/ethnicity. Excludes 59,824 cases of non-Hispanic unknown race. § Percentage of total for localized, regional, distant, and unknown is 77%, 11%, 5%, and 8%, respectively. ¶ CI could not be calculated. TABLE 3 Five-year relative survival for men with prostate cancer, by period and selected characteristics — United States, 2001–2016* Characteristic 2001–2016 2001–2005 2006–2010 2011–2016 No. Relative survival % (95% CI) No. Relative survival % (95% CI) No. Relative survival % (95% CI) No. Relative survival % (95% CI) Overall 3,104,380 97.6 (97.5–97.6) 965,748 97.3 (97.2–97.4) 1,052,255 98.2 (98.1–98.3) 1,086,532 97.2 (97.1–97.3) Age group (yrs) ≤49 83,692 96.7 (96.6–96.9) 25,688 96.3 (96.0–96.6) 31,384 97.1 (96.8–97.3) 26,621 96.9 (96.5–97.2) 50–54 214,757 97.8 (97.6–97.9) 63,318 97.8 (97.6–98.0) 76,549 97.9 (97.7–98.1) 74,893 97.4 (97.2–97.7) 55–59 407,302 98.4 (98.3–98.5) 117,213 98.6 (98.4–98.7) 143,170 98.6 (98.5–98.7) 146,920 97.7 (97.5–97.9) 60–64 559,872 98.8 (98.8–98.9) 154,088 98.7 (98.6–98.9) 195,058 99.2 (99.1–99.4) 210,727 98.4 (98.2–98.6) 65–69 650,004 99.6 (99.5–99.7) 185,518 99.1 (98.9–99.3) 213,975 99.9 (99.7–100.0) 250,514 99.5 (99.3–99.6) 70–74 525,876 99.5 (99.4–99.6) 175,220 99.1 (98.8–99.3) 171,457 99.9 (99.9–100.0) 179,201 99.3 (99.0–99.4) 75–79 361,735 98.4 (98.2–98.6) 134,039 98.0 (97.6–98.3) 120,166 99.0 (98.7–99.2) 107,532 97.7 (97.4–98.0) ≥80 301,315 84.6 (84.2–84.9) 110,671 85.7 (85.2–86.3) 100,506 86.9 (86.3–87.4) 90,144 79.7 (78.9–80.6) Race/Ethnicity† White 2,323,828 97.9 (97.9–98.0) 752,786 97.8 (97.7–97.9) 792,482 98.6 (98.5–98.6) 778,682 97.3 (97.2–97.5) Black 459,665 95.6 (95.4–95.7) 130,818 94.8 (94.6–95.1) 152,416 96.1 (95.9–96.3) 176,445 95.7 (95.3–95.9) AI/AN 11,983 95.7 (94.7–96.6) 3,361 94.6 (92.7–96.1) 3,991 96.4 (94.8–97.5) 4,632 95.5 (93.2–97.1) API 55,310 95.1 (94.8–95.5) 14,865 95.4 (94.7–96.0) 18,207 95.5 (94.9–96.0) 22,241 94.7 (93.9–95.3) Hispanic 193,770 95.3 (95.1–95.5) 52,951 94.9 (94.5–95.2) 64,680 96.0 (95.7–96.3) 76,154 95.2 (94.8–95.6) Stage* Localized 2,393,365 100.0§ 753,909 100.0§ 836,008 100.0§ 803,466 100.0§ Regional 328,421 98.6 (98.5–98.7) 87,320 97.5 (97.3–97.8) 106,635 99.0 (98.8–99.2) 134,467 99.3 (98.9–99.5)¶ Distant 145,923 30.7 (30.4–31.0) 37,195 28.7 (28.1–29.2) 40,895 30.2 (29.7–30.8) 67,835 32.3 (31.6–33.0)¶ Unknown 236,919 84.3 (84.0–84.5) 87,357 83.0 (82.6–83.4) 68,748 84.2 (83.7–84.6) 80,818 86.7 (86.1–87.2)¶ Stage by race/ethnicity Localized  White 1,807,824 100.0§ 592,631 100.0§ 634,465 100.0§ 580,741 100.0§ Black 354,643 100.0§ 99,964 100.0§ 121,260 100.0§ 133,420 100.0§ AI/AN 8,626 100.0§ 2,477 99.9 (97.3–100.0) 2,960 100.0§ 3,189 100.0§ API 41,192 99.6 (99.1–99.8) 11,622 99.6 (98.1–99.9) 13,940 99.6 (98.6–99.9) 15,631 99.8 (97.4–100.0) Hispanic 142,007 100.0§ 39,557 100.0§ 48,798 100.0§ 53,655 100.0§ Regional White 254,394 98.6 (98.5–98.8) 68,723 97.5 (97.2–97.7) 83,382 99.0 (98.7–99.2) 102,290 99.4 (99.0–99.7)¶ Black 42,843 98.8 (98.3–99.1) 11,027 97.9 (96.9–98.5) 13,494 99.3 (98.3–99.7) 18,322 98.9 (97.7–99.5) AI/AN 1,366 98.2 (93.2–99.5) 354 97.3 (87.8–99.4) 431 98.5 (82.2–99.9) 581 97.5 (79.3–99.7) API 6,671 97.4 (96.5–98.1) 1,491 97.1 (95.0–98.4) 2,091 97.9 (96.3–98.9) 3,089 96.9 (94.7–98.2) Hispanic 20,794 97.5 (97.0–98.0) 5,145 96.8 (95.7–97.7) 6,424 97.9 (96.9–98.5) 9,225 98.0 (96.7–98.8) Distant  White 101,621 29.1 (28.7–29.5) 25,864 27.2 (26.6–27.9) 28,392 28.5 (27.9–29.1) 47,367 30.8 (29.9–31.6)¶ Black 28,330 31.6 (30.9–32.3) 7,718 29.9 (28.6–31.1) 8,047 31.0 (29.9–32.2) 12,565 33.3 (31.8–34.9)¶ AI/AN 796 32.2 (27.8–36.8) 180 29.0 (21.6–36.8) 219 27.9 (21.3–34.8) 397 39.0 (30.4–47.4) API 3,153 42.0 (39.6–44.3) 650 38.1 (33.9–42.3) 853 43.3 (39.5–47.0) 1,650 41.5 (36.8–46.1) Hispanic 11,418 37.2 (36.1–38.4) 2,655 35.3 (33.3–37.4) 3,213 37.4 (35.5–39.3) 5,550 37.5 (35.2–39.9) Unknown White 160,180 82.8 (82.5–83.2) 65,593 83.3 (82.8–83.8) 46,266 82.0 (81.4–82.5) 48,322 83.0 (82.2–83.8) Black 33,879 79.1 (78.3–79.8) 12,113 78.3 (77.1–79.5) 9,619 78.8 (77.5–80.0) 12,148 80.9 (79.3–82.4) AI/AN 1,196 82.2 (78.1–85.7) 350 76.9 (69.4–82.8) 381 84.6 (77.6–89.6) 465 84.1 (74.8–90.3) API 4,298 82.7 (80.9–84.4) 1,102 82.0 (78.5–84.9) 1,323 81.1 (78.0–83.7) 1,873 85.4 (81.5–88.5) Hispanic 19,572 84.4 (83.5–85.2) 5,598 80.6 (79.0–82.1) 6,249 86.5 (85.1–87.7) 7,727 85.8 (83.9–87.6)¶ Source: CDC’s National Program of Cancer Registries. https://www.cdc.gov/cancer/npcr. Abbreviations: AI/AN = American Indian/Alaska Native; API = Asian/Pacific Islander; CI = confidence interval. * Data were compiled from 45 population-based registries that cover approximately 94% of the U.S. population. Counts for age and stage do not sum to the total because of multiple primaries methodology. When the relative survival is calculated stratified by a tumor or demographic characteristic, each cancer was included for patients diagnosed with multiple primary prostate cancers at the different category levels.  †White, Black, AI/AN, and API men are non-Hispanic. Hispanic men might be of any race. Counts exclude unspecified or unknown race/ethnicity. Excludes 59,824 cases of non-Hispanic unknown race. § CI could not be calculated. ¶ Indicates nonoverlapping 95% CIs when comparing 2001–2005 with 2011–2016.