Abstract Background Prostate cancer mortality rates in the United States declined sharply after 1991 in White men and declined after 1992 in African American men. The current study was conducted to investigate possible mechanisms for the declining prostate cancer mortality rates in the United States. Methods The authors examined and compared patterns of prostate cancer incidence, survival rates, and mortality rates among African American men and White men in the United States using the 1969–1999 U.S. prostate cancer mortality rates and the 1975–1999 prostate cancer incidence, survival, and incidence-based mortality rates from the Surveillance, Epidemiology, and End Results (SEER) Program for the U.S. population. The SEER data represent approximately 10% of the U.S. population. Results Prostate cancer incidence and mortality rates showed transient increases after 1986, when the U.S. Food and Drug Administration approved the use of prostate specific antigen (PSA) testing. The age-adjusted prostate cancer mortality rates for men age 50 to 84 years, however, have dropped below the rate in 1986 since 1995 for White men and since 1997 for African American men. In fact, for White men ages 50–79 years, the 1998 and 1999 rates were the lowest observed since 1950. Incidence-based mortality rates by disease stage revealed that the recent declines were because of declines in distant disease mortality. Moreover, the decrease in distant disease mortality was because of a decline in distant disease incidence, and not to improved survival of patients with distant disease. Conclusions Similar incidence, survival, and mortality rate patterns are seen in African American men and White men in the United States, although with differences in the timing and magnitude of recent rate decreases. Increased detection of prostate cancer before it becomes metastatic, possibly reflecting increased use of PSA testing after 1986, may explain much of the recent mortality decrease in both white men and black men.