As a radiation oncologist, I help people with cancer.
According to the American Cancer Society, prostate cancer is the most common cancer among men and the second-leading cause of cancer deaths.
About one in 44 American men will die of the disease.
Although some prostate cancers are aggressive — and can lead to death — the majority of them are low-grade and never spread (metastasize) to distant sites like bones.
What if I told you that there is a male behavior that raises prostate cancer risk by nearly half?
What’s your guess?
Smoking?
Too much alcohol?
Not enough exercise?
No, the answer is simpler: Get prostate cancer screening.
Today, I’ll review the disturbing recent increase in prostate cancer incidence.
We’ll then turn to a new study highlighting the power of prostate cancer screening.
Prostate Cancer Rates Are Spiking
The U.S. state of California is a good example of what happens when men don’t get prostate cancer screening.
A University of California, San Francisco (UCSF) study included nearly 388,000 men who had prostate cancer between 2004 and 2021.
This California statistic caught my eye:
The incidence rate of prostate cancer cases increased by seven percent per year on average between 2011 and 2021.
Around one in six of the 72,460 men invited to the screenings skipped every appointment.
The unscreened men had a 45 percent higher risk of dying from prostate cancer compared with those who attended screening appointments.
Let’s turn to why this spike rise in incidence (and plateau in gains against prostate cancer deaths) occurred.
Prostate Screening Stops (and Deaths Rise)
The incidence of advanced prostate cancer rose.
The mortality rate plateaued in most regions across the state of California.
These changes occurred following the decision to stop routinely screening all men for the disease.
The prostate cancer increase is associated with the 2012 U.S Preventative Task Force decision to stop recommending routine PSA screenings.
Guidelines Changed Over Time
Let’s look at how prostate cancer screening guidelines have evolved:
- 2008. The U.S. Preventative Services Task Force (USPSTF) recommends against PSA screening for males over 75.
- 2012. The USPSTF extends the “no PSA screening” recommendation to men 55 to 69.
- 2018. “Males aged 55 to 69 years discuss the possible benefits and harms of PSA screening with their health care provider and make an individualized decision about whether to get screened.”
Prostate Cancer: Screening
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential…
www.uspreventiveservicestaskforce.org
The 2008 and 2012 changes, designed to prevent overtreatment, may have inadvertently led to a higher number of cases going undetected (and potentially advanced, lethal prostate cancer).
My Take
The rising incidence of prostate cancer alarms me.
The increase occurred across age groups, ethnicities, and races.
The freeze in screenings “unfortunately may have led to one of the largest subsequent rises in incidence of distant stage disease.”
The problem is urgent, and determining the optimal way to screen for prostate cancer remains a challenge.
Screen!
If we don’t screen, the number of men diagnosed with advanced prostate cancer — an incurable condition — increases fast.
If you are a male, you should strongly consider prostate cancer screening with the PSA (prostate-specific antigen) blood test.
The American Cancer Society recommends that men have a chance to make an informed decision with their healthcare provider about whether to be screened for prostate cancer.
After learning about the possible benefits, risks, and uncertainties of prostate cancer screening, you can make a decision.
The discussion about screening should take place at:
- Age 50 for men who are at average risk of prostate cancer and have a life expectancy of at least 10 years.
- Age 45 for men at high risk of developing prostate cancer. This group includes African American men and those who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).
- Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age)
