Reversing a trend that saw the number of new prostate cancer cases drop sharply between 2007 and 2014, the American Cancer Society (ACS) reports an increase in prostate cancer incidence between 2014 and 2019.
In its annual report published in CA: A Cancer Journal for Clinicians, the ACS compiles the most recent data on cancer occurrence and outcomes. This year’s report, Cancer statistics, 2023, includes some updates about prostate cancer. From 2014 to 2019, the incidence rate increased by about 3% each year. That means nearly 100,000 more cases occurred than if rates had stayed the same. Furthermore, of those extra cases, about half of them were advanced, which means they’re harder to cure.
WHAT’S BEHIND THE INCREASE?
The ACS says this rise is likely a result of changes to prostate-specific antigen (PSA) screening guidelines. In 2012, the US Preventive Services Task Force (USPSTF) changed their guidelines to recommend against routine PSA screening. At the time, the task force argued that routine testing can lead to overdiagnosis and overtreatment of prostate cancers that aren’t dangerous.
However, groups like the Prostate Conditions Education Council (PCEC) say the change in guidelines hasn’t had the positive effect the USPSTF may have hoped it would.
“Not only is the incidence of prostate cancer increasing, but we are also sadly finding more cases of advanced prostate cancer,” says PCEC Founder and Chairman E. David Crawford, MD. “The concerns raised concerning cancer screening by groups developing physician guidelines has negatively influenced the ability of men to receive lifesaving early detection.”
RACIAL DISPARITIES IN PROSTATE CANCER INCIDENCE
The increased number of prostate cancer cases is even more alarming for Black men, who face a 70% higher incidence rate compared to white men. In addition, the overall 5-year survival rate dropped from 98% to 97%, but the mortality rates in Black men are approximately two to four times higher compared to every other racial and ethnic group.
Dr. Reggie Tucker-Seeley, Vice President of Health Equity for ZERO – The End of Prostate Cancer, says this racial disparity is the result of “the sorting of money, knowledge, power, and beneficial social connections.” It’s also a major deterrent in the fight against prostate cancer.
“We cannot end prostate cancer without addressing the root causes of race and place-based disparities in prostate cancer,” says Dr. Tucker-Seeley.
TRYING TO REGAIN LOST GROUND
Despite confusing guidelines and delays in diagnosis brought on by the COVID-19 pandemic, there are ongoing efforts to regain lost ground. Rather than a blanket recommendation against routine PSA screening, the USPSTF updated their guidelines in 2018 to encourage informed decision-making between each individual and his physician about the pros and cons of PSA screening. While those guidelines are for men aged 55 to 69, the ACS recommends starting that conversation at age 50 for average risk men. For men at higher risk, screening discussions could start even earlier.
In addition to PSA screening, researchers have also developed more targeted tests and tools to better screen and diagnose prostate cancer. “We also can better differentiate prostate cancers that will be deadly,” says Dr. E. David Crawford, Professor of Urology at University of California San Diego. “Our goal now is to find early cancers early and those later cancers as early as possible.”
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Prostate cancer patients typically have several treatment options depending on the grade and stage of their disease. If you or someone you know has been diagnosed with prostate cancer, we recommend speaking to a proton-experienced radiation oncologist to make sure you understand all your options.