Objective:

To characterize 25-year trends in prostate cancer mortality with co-documented bone metastasis, quantify divergence from underlying-cause surveillance, and project age-adjusted mortality rates (AAMRs) to 2040 across demographic and geographic subgroups.

Approach:

• Data Source: Queried CDC WONDER (1999–2024) for deaths with prostate cancer as the underlying cause and bone metastasis as a contributing cause.
• Analysis Method: Used joinpoint regression for temporal trends and ARIMA/exponential smoothing models for projections.
• Stratification: Analyses were stratified by age, race/ethnicity, US Census region, and urbanization.

Key Findings:

• 73,429 deaths met the dual-code definition.
• Overall AAMR rose 93%, from 1.10 to 2.12 per 100,000 (AAPC: +2.61%; 95% CI: 1.66–3.56; p < 0.000001).
• Initial decline from 1999 to 2006 (APC: −5.57%) followed by acceleration from 2013 to 2018 (APC: +12.91%).
• Non-Hispanic Black or African American men had a mean AAMR 64% higher than non-Hispanic White men (1.89 vs. 1.15 per 100,000).
• Projected AAMR to reach 3.65 (95% CI: 0.88–6.43) by 2040 with substantial uncertainty.

Interpretation:

MCOD surveillance identified an increase in co-documented prostate cancer and bone-metastasis deaths, diverging from the declining underlying-cause-only trend.

Limitations:

• Estimates reflect documented bone metastasis rather than true incidence.
• May be affected by evolving documentation and coding practices, which could influence the accuracy of the data.

Conclusion:

Findings indicate the need for incorporating MCOD-based metrics into national prostate cancer surveillance and evaluating care needs in higher-burden subgroups.