Prior to his prostate cancer diagnosis, Barry Katz had no symptoms – no pain, no trouble urinating, no warning signs.
When routine blood work revealed his PSA score – an indicator of prostate problems – had jumped, his doctors moved quickly.
Scans and a biopsy confirmed the diagnosis, and within weeks his prostate cancer had been removed. Today, he remains cancer-free.
This is how it is supposed to go. When caught early, prostate cancer is highly treatable, with a near 100 percent survival rate. But millions of American men face a very different reality.
New federal data analyzed by the Daily Mail reveals stark geographic divides in both diagnosis and death rates. It suggests that where a person lives can be as important as their genetics in determining outcomes.
As our maps reveal, men in parts of the South are far more likely to be diagnosed late and die. In the Northeast, higher screening rates in some states mean more cancers are found, and more lives are saved.
In rural America, long distances and lack of insurance mean many cancers are not caught in time.
The difference is not who gets cancer – it’s who gets diagnosed early enough to survive it.
The first sign of prostate cancer is often a PSA test, the simple blood test that detects levels of prostate specific antigen.
Higher readings are a sign that something is wrong with the gland.
However, PSA testing is imperfect. Levels can rise for numerous benign reasons, including age-related prostate enlargement, vigorous exercise or sexual activity.
For this reason, doctors often adopt a watch and wait approach, particularly when no other symptoms are present. But this only works when patients can easily access follow-up care.
For Katz, a raised PSA quickly led to a diagnosis. For many other men, particularly those in lower income or rural areas, this pathway is far less certain.
Specialist imaging has historically been concentrated in hospitals, often far from rural communities. Men without good insurance can face long waits, long drives or the decision not to pursue further testing at all.
When screening is inconsistent and follow-up care is delayed, cancers are found later.
And these are perhaps clues as to why the federal figures reveal three Americas when it comes to prostate cancer.
In states like Louisiana, Mississippi and Georgia, prostate cancer rates are among the highest in the country. Louisiana records around 147 cases per 100,000 men, while Georgia sees 141 and Mississippi 139.
Crucially, these are not places where more men develop the disease – they are places where more men die from it.
For Mississippi in particular, the picture is bleak, with almost 25 deaths per 100,000 men in the population attributed to prostate cancer, making it the worst-hit state.
There, the drivers are likely structural: poverty, lack of health insurance, limited access to screening and preventive care, fewer primary care doctors and long travel distances to specialists.
Environmental actors may also play a role. In Louisiana’s Cancer Alley – an 85-mile stretch along the Mississippi River where more than 150 chemical plants release toxic pollution – the risk of developing some form of the disease is about 50 percent higher than the national average.
These facilities were built on former plantations, and the surrounding communities remain predominantly Black – a group already at double the risk of prostate cancer.
Meanwhile, in the Northeast, there are high numbers of diagnoses, but also better survival rates.
Barry Katz, right, with his son. A routine PSA test saved his life. For millions of American men, the story is very different
New Jersey records almost 147 cases per 100,000 men, while Maryland’s numbers show 142 – both higher than the rate in Georgia.
New York is also up there, with 135 cases per 100,000 – greater than North Carolina (132), South Carolina (115) and Alabama (113).
However, the studies suggest there is a very different reason for the numbers. Access to healthcare in these northern states is excellent, which results in more men being screened and diagnosed.
For instance, an American Cancer Society report found that prostate cancer rates in New Jersey rose substantially between the mid-1980s and ’90s, ‘reflecting the widespread adoption of screening with the PSA blood test.’
In the Garden State, the prostate cancer death rate is 16 per 100,000 men – putting it among the lowest in America.
In the Midwest, environmental exposures may be key.
In parts of the Upper Midwest, including Iowa, Wisconsin, South Dakota and Kansas, rates are at or above 125 cases per 100,000 men and rising.
Farmers in Midwestern states face prolonged contact with pesticides and fertilizers linked to prostate cancer.
Pesticides, including nitrates, leach into the soil and seep into the water supply.
Studies have linked higher nitrate levels in water supplies – particularly from private wells – to an increased risk of aggressive prostate cancer.
In Louisiana’s Cancer Alley – an 85-mile stretch along the Mississippi River where more than 150 chemical plants release toxic pollution – the risk of developing some form of the disease is about 50 percent higher than the national average
The long-term Agricultural Health Study of farmers and their families in Iowa and North Carolina followed more than 40,000 participants for nearly 22 years.
It found that men who are exposed to high levels of nitrates in drinking water had a 22 percent higher risk of developing aggressive prostate cancer.
The problem is growing most quickly in several states.
Connecticut’s rate is already high at 136.7 cases per 100,000, and it is increasing by 3.7 percent annually. Iowa, with 129.5, and Wisconsin, with 126.7, are seeing rapid annual increases of 3.4 percent.
Other states with troubling rises include Georgia at 2.6 percent, Louisiana at 2.7 percent, Maryland at 2.5 percent, New York at 2.4 percent and New Jersey at 2.2 percent.
Some states with rates below the national average are also seeing alarming increases.
Vermont has a relatively modest rate of 114.1 cases per 100,000, but it is climbing by a staggering 6.2 percent every year – the fastest rise in the entire NIH dataset.
Alaska (107.7) is rising by 5.2 percent annually, while Maine (108.5) is up 3.2 percent.
In these states, the problem is still smaller than in Louisiana or New Jersey, but it is growing much more quickly. Without intervention, they could become the next hotspots.
The data shows that prostate cancer in America is not a single, equal-opportunity disease.
It is a collection of regional epidemics, each driven by different forces: pollution in the South, poverty in Georgia, agricultural chemicals in the Midwest and high screening rates in the Northeast.
Most importantly, it shows that where a person lives may be just as important as their family history in determining whether they survive.
