What We Can Learn from the Increase in Prostate Cancer

Troubling Prostate Cancer Statistics

The increase in prostate cancer cases come after two decades of decline. Statistics from the American Cancer Society show that the incidence of prostate cancer grew by 3 percent each year from 2014 to 2019, equaling about 99,000 new cases over that period. (The American Cancer Society estimates that there will be slightly over 299,000 new cases of the disease in 2024, and more than 35,000 deaths from prostate cancer.)

Much of the increase identified from 2014 to 2019 represents advanced cases. While the overall rate of prostate cancer cases rose by about 3 percent annually, the number of cases of regional and distant prostate cancer has been increasing at a greater rate – about 4.5% annually — since around 2011. Additionally, these high-risk prostate cancers appear to affect more younger adult men than they did in the past.

PSA Screening and Its Impact on Prostate Cancer Diagnoses

While the reported rise in prostate cancer cases is discouraging, some medical experts say that the trend may have less to do with human biology than with public policy. They explain that prostate cancer was on the decline for several years before rates began increasing. They also note that in 2008, the United States Preventive Services Task Force (USPSTF) – a volunteer body of public health experts that makes recommendations to the federal government – changed its guidelines to recommend against measuring blood levels of an enzyme known as prostate-specific antigen (PSA) to screen for prostate cancer in men 75 and older. These guidelines were revised again in 2012 to recommend against routine PSA screening in men of any age.

It may seem odd that the USPSTF would suggest not using a screening test for prostate cancer. However, PSA levels can be elevated for many reasons – including infections and age-related enlargement of the prostate gland – as well as due to prostate cancer. Citing this fact, the USPSTF noted that investigating elevated PSA findings by performing biopsies and other tests raised the possibility that men who did not have prostate cancer would develop procedure-related complications, such as infections following biopsy. Additionally, the Task Force noted that elevated PSA findings could even lead to some men being treated for prostate cancer when they didn’t actually have the disease, exposing them to unnecessary medical care, costs, and potential complications of therapy. After weighing the potential benefits and harms of PSA screening, the USPSTF issued its recommendation against the practice. Several – but not all – medical societies then adopted the recommendation, and many public and private insurers decided not to reimburse for routine PSA screening.  

The USPSTF changed its recommendations in 2018 to advise men between ages 55 and 69 that they should consult their doctors about receiving PSA screening, and to discuss the benefits and risks of the screening. More recently, the Task Force announced that it would further review its recommendations.

While the USPSTF guidelines are evolving, the impact of the 2012 recommendation continues to be felt. PSA screening declined significantly in the years following that recommendation. Many urologists and others say that the result is that fewer men were diagnosed when their prostate cancer was in its early stages, and instead were not diagnosed until they experienced signs and symptoms of more-advanced disease. This, they add, explains why the rate of regional and distant prostate cancers has risen faster than the rate of localized cancers.

Implications of Prostate Cancer Statistics on PSA Screening

While the best approach to PSA screening continues to be debated, there is no debate about the importance of early detection of prostate cancer. According to the American Cancer Society, the five-year relative survival rate for localized cancer that has not spread outside the prostate is 99 percent. Compare this figure with the 32 percent five-year survival rate for distant cancer.

For this reason, the American Urological Association’s recommendations differ from those of the USPSTF. The group says doctors may begin prostate cancer screening and offer a baseline PSA test to most patients when they are between 45 and 50 years of age. However, the urology group adds that clinicians should offer prostate cancer screening at age 40 to 45 years for patients who are at elevated risk by virtue of factors such as:

• Being of African descent
• Having inherited gene changes, such as BRCA1 and BRCA2 mutations or Lynch syndrome, a genetic condition that raises a person’s risk for several types of cancer
• Having a strong family history of prostate cancer, including having a

 father or brother who developed prostate cancer

Innovations in Prostate Cancer Screening

Additional technologies and techniques beyond measurement of serum PSA help physicians screen for and diagnose prostate cancer. For example, if screening reveals elevated PSA levels, multiparametric magnetic resonance imaging (MRI) can help doctors pinpoint the area from which to collect a sample of prostate tissue during a biopsy.

Other tests can increase the information obtained from PSA screening such as assessments of PSA density and calculation of the prostate health index (PHI). A blood test called 4K analyzes four PSA-related proteins to determine prostate cancer risk. Urine screening can help doctors detect genetic markers for prostate cancer.

Genomic biomarker tests represents another innovation changing prostate cancer screening, particularly for Black men who are at a higher risk for the disease than men in other racial and ethnic groups. Black men are more likely than others to be at risk for genomically aggressive cancer. Genomic biomarkers provide insight into a cancer’s aggressiveness. This allows doctors to categorize patients with prostate cancer as being low, intermediate, or high risk when choosing treatments.

Treatment for Prostate Cancer at RCCA

As patients navigate prostate cancer and its treatment, they can receive compassionate, comprehensive care and the latest therapies from the medical oncologists of RCCA. Specializing in all aspects of oncology and hematology, the team at Regional Cancer Care Associates provides state-of-the-art prostate cancer treatment at more than 20 locations in New Jersey, Connecticut, Maryland, and the Washington, D.C., area. Contact RCCA to learn more about prostate cancer treatment or schedule an appointment at one of our locations.