New VA Study Reveals Rising Burden of Advanced Prostate Cancer Among Veterans
Prostate cancer (PCa) remains the most common nonskin malignancy among veterans and one of the leading causes of cancer-related deaths in men across the US. While 1 in 8 men in the general population will develop prostate cancer in their lifetime, the risk rises dramatically for US veterans—affecting 1 in 5. This higher risk has been linked to aging demographics and military exposures to carcinogens such as Agent Orange and burn pits.
A recent study published in the Journal of the National Comprehensive Cancer Network offers the most comprehensive look to date at metastatic castration-resistant prostate cancer (mCRPC) among veterans, leveraging data from more than 1.1 million prostate cancer cases in the VA’s Prostate Cancer Datacore. Using a validated natural language processing (NLP) tool, researchers identified over 44 000 veterans with mCRPC, providing critical insights into incidence, survival, and regional trends.
Between 2005 and 2022, the prevalence of mCRPC among veterans rose from 11 to 16 per 1000 prostate cancer cases, showing a significant upward trend. Although the incidence of new cases slightly declined after peaking in 2018, overall survival rates improved notably, rising from 1.23 years (2005–2011) to 2.17 years (2018–2024). These gains reflect advancements in imaging and treatment, including the introduction of next-generation androgen receptor pathway inhibitors such as abiraterone and enzalutamide, as well as improved diagnostic techniques like PSMA PET/CT scans.
Regional analyses revealed higher rates of mCRPC in the western US, with the highest prevalence in Washington, California, Nevada, Utah, and New Mexico. The reasons for this geographic disparity remain unclear but may relate to differences in environmental exposures, health care access, or demographic factors.
The average veteran diagnosed with mCRPC was approximately 75 years old, with 69% identifying as White and 27% as Black—highlighting persistent racial disparities in prostate cancer burden. Many veterans had multiple comorbidities (57% with a Charlson Comorbidity Index ≥5) and elevated PSA levels at diagnosis. Veterans with “de novo” metastatic disease—those whose cancer was advanced from the outset—progressed more rapidly to mCRPC (median 5.7 years) than those whose disease spread later (median 11 years).
While survival among veterans with mCRPC has improved, the disease remains aggressive and ultimately fatal, with median survival still near two years after diagnosis. The study underscores the urgent need for continued research to delay disease progression, improve quality of life, and understand biological and environmental contributors unique to the veteran population.
By combining robust real-world data with cutting-edge analytics, this landmark VA study sets the foundation for more targeted prevention, earlier detection, and personalized treatment strategies for veterans facing one of the most challenging forms of prostate cancer.
Reference
Candelieri-Surette D, Lee J, Lynch JA, et al. Epidemiology of Metastatic Castration-Resistant Prostate Cancer in Veterans Nationwide. J Natl Compr Canc Netw. 2025;23(8):307-313. Published 2025 Jul 14. doi:10.6004/jnccn.2025.7032
