The global, regional, and national prostate cancer burden and trends from 1990 to 2021, results from the global burden of disease study 2021

Abstract

Background: The rising annual incidence of prostate cancer (PCa) has become a significant health challenge for men worldwide. The study aims to estimate the contemporary disease burden of PCa across global, regional, and national levels.

Methods: Data from the Global Burden of Disease Study 2021 (GBD 2021) was analyzed to evaluate trends in PCa incidence, prevalence, disability-adjusted life years (DALYs), and mortality from 1990 to 2021. Determinants of PCa burden were investigated through Spearman correlation analysis with socio-demographic index (SDI), decomposition analysis, and frontier analysis to assess regional improvement potential.

Results: In 2021, global PCa incidence reached 1.32 million cases [95% uncertainty interval (UI): 1217320.93, 1400222.17]. Between 1990 and 2021, the global estimated annual percentage change (EAPC) of age-standardized incidence rates (ASIR), prevalence rates (ASPR), DALYs rates (ASDR), and mortality rates (ASMR) were declined or increased at -0.06% [95% confidence interval (CI): -0.21, 0.08], 0.42% (95% CI: 0.26, 0.58), -0.96% (95% CI: -1.05, -0.87), and -0.58% (95% CI: -0.73, -0.44), respectively. Low-middle SDI countries exhibited the steepest rate increases, with males over 50 years being most affected. Significant positive correlations emerged between SDI levels and ASIR (R = 0.543, p < 0.001) or ASPR (R = 0.709, p < 0.001), whereas EAPC of ASDR (R = -0.430, p < 0.001) or ASMR (R = -0.450, p < 0.001) inversely correlated with SDI among 204 countries and territories. Decomposition analysis revealed the global increase of DALYs for PCa was predominantly attributed to aging (77.65%) and population growth (58.59%). Frontier analysis identified substantial improvement potential across development spectra, particularly in middle to high SDI regions.

Conclusion: Our findings demonstrated that despite modest declines in ASDR and ASMR within high SDI regions, PCa burden metrics persistently increased in low-middle SDI quintiles. Nations across all development levels require urgent implementation of evidence-based policies and precision management strategies to mitigate this growing public health challenge.

Keywords: disability-adjusted life years; global burden of disease study; incidence; mortality; prevalence; prostate cancer.

Figure 1

Temporal trends in EAPC of ASIR (A), ASPR (B), ASDR (C), and ASMR (D) for PCa across global, SDI quintiles, and 21 GBD regions from 1990 to 2021. SDI, socio-demographic index; ASIR, age-standardized incidence, ASPR, age-standardized prevalence, ASDR, age-standardized disability-adjusted life years; ASMR, age-standardized mortality; PCa, prostate cancer; EAPC, estimated annual percentage change; PCa, prostate cancer; GBD, Global Burden of Disease; SDI, socio-demographic index.

Figure 2

Temporal trends of incidence, prevalence, DALYs, and mortality (A) and their corresponding ASIR, ASPR, ASDR, and ASMR (B) for PCa in global and SDI quintiles from 1990 to 2021. SDI, socio-demographic index; ASIR, age-standardized incidence; ASPR, age-standardized prevalence; ASDR, age-standardized disability-adjusted life years; ASMR, age-standardized mortality; DALYs, disability-adjusted life years; PCa, prostate cancer; SDI, socio-demographic index.

Figure 3

Comparison of ASIR (A), ASPR (B), ASDR (C), and ASMR (D) of PCa in global and 21 GBD regions in 1990 versus 2021. ASIR, age-standardized incidence; ASPR, age-standardized prevalence; ASDR, age-standardized disability-adjusted life years; ASMR, age-standardized mortality; PCa, prostate cancer; GBD, Global Burden of Disease.

Figure 4

Global distribution of PCa incidence burden across 204 countries and territories. (A) The incidence of PCa in 2021; (B) ASIR in 2021; (C) EAPC in ASIR from 1990 to 2021. ASIR, age-standardized incidence; EAPC, estimated annual percentage change; PCa, prostate cancer.

Figure 5

Age-specific burden of PCa in 2021. Crude rate and total number of incidence cases (A), prevalence cases (B), DALYs (C), and mortality (D). DALYs, disability-adjusted life years; PCa, prostate cancer; UI, uncertainty interval.

Figure 6

Correlations between SDI and age-standardized rates (ASIR, ASPR, ASDR, ASMR) of PCa across 21 GBD regions from 1990 to 2021. ASR, age-standardized rates; DALYs, disability-adjusted life years; PCa, prostate cancer; ASIR, age-standardized incidence; ASPR, age-standardized prevalence; ASDR, age-standardized disability-adjusted life years; ASMR, age-standardized mortality; GBD, Global Burden of Disease; SDI, socio-demographic index.

Figure 7

National-level associations between SDI and age-standardized rates (ASIR, ASPR, ASDR, ASMR) of PCa in 2021. ASR, age-standardized; DALYs, disability-adjusted life years; PCa, prostate cancer; ASIR, age-standardized incidence; ASPR, age-standardized prevalence; ASDR, age-standardized disability-adjusted life years; ASMR, age-standardized mortality; SDI, socio-demographic index.

Figure 8

Correlation analysis between SDI and EAPCs of ASIR, ASPR, ASDR, or ASMR for PCa across 204 countries and territories in 2021. Dot size reflects case counts. DALYs, disability-adjusted life years; PCa, prostate cancer; ASIR, age-standardized incidence; ASPR, age-standardized prevalence; ASDR, age-standardized disability-adjusted life years; ASMR, age-standardized mortality.

Figure 9

Decomposition analysis of PCa-related DALYs by population growth, aging, and epidemiological trends in worldwide and across SDI quintiles from 1990 to 2021. The black dot represents total net change; positive values indicate contributing increases to DALYs. DALYs, disability-adjusted life years; PCa, prostate cancer; SDI, socio-demographic index.

Figure 10

Frontier analysis of PCa-related ASDR and SDI trajectories across 204 countries and territories from 1990 to 2021. (A) Temporal progression of ASDR-SDI relationships, with gradient shading (light to dark blue) denoting years from 1990 to 2021. (B) Efficiency frontier (solid black line) comparing ASDR and SDI trends over time. Red dots represent countries with reduced ASDR from 1990 to 2021; blue dots denote increased ASDR for PCa from 1990 to 2021. Highlighted labels include: top five low-SDI countries with minimal effective difference from the frontier (blue), high-SDI countries with substantial effective difference (red), and the top 15 countries exhibiting the largest effective difference (black). PCa, prostate cancer; SDI, socio-demographic index; ASDR, age-standardized disability-adjusted life years.