More men diagnosed with advanced prostate cancer as PSA tests drop

More men are being diagnosed with advanced prostate cancer that is less likely to respond to treatment, according to a new study from the American Cancer Society.

Prostate cancer, which is the second leading cause of cancer death for men in the United States, increased by 3% per year from 2014 to 2019 after two decades of decline, with the increase mainly due to disease diagnoses advanced, researchers reported Thursday in California: A Cancer Journal for Clinicians.

The increases are “worrying,” said the study’s lead author, Rebecca Siegel, senior scientific director of surveillance research at the American Cancer Society. That’s because prostate cancer that has spread to distant sites beyond the organ is “extremely difficult to treat,” Siegel said. “There is no lasting cure for people with metastatic disease,” she added.

Doctors review ultrasound and MRI images of a prostate biopsy
Doctors review ultrasound and MRI images of a prostate biopsy at the Stanford Cancer Center in Palo Alto, California.Michael Macor/The San Francisco Chronicle via Getty Images File

The rise in cases of fatal prostate cancer may be partly linked to recommendations against prostate-specific antigen, or PSA, for screening healthy men, experts suggest.

In the new report, Siegel and his colleagues found that advanced-stage prostate cancer diagnosis has increased 4-5% per year since 2011.

“In 2019, 8% were diagnosed at a distant stage, compared to 4% in 2011, and 14% were diagnosed at a regional stage, compared to 11% in 2011, for a total of 22% at an advanced stage,” said Siegel told NBC. News.

Once prostate cancer has spread away from the original tumour, the prognosis is poor. The five-year survival rate for these cancers is 32%, according to Siegel.

The increase in the number of deaths from prostate cancer is even more concerning than the increase in diagnoses of advanced cancer.

In 2017, about 26,730 men died from prostate cancer, while in 2022 that number rose to about 34,500, said Dr. Ash Tewari, director of urology at the Icahn School of Medicine at Mount Sinai in New York.

“This increase is concerning and requires a fresh look at prostate cancer screening,” Tewari said. “Each year, 8,000 more men die. Basically, it’s like 16 Boeing 747s crashing.

Black men had a 70% higher incidence of prostate cancer than white men. Prostate cancer death rates were two to four times higher among black men than among men of all other racial and ethnic groups, the researchers found.

Decline in prostate cancer screening

In 1994, the Food and Drug Administration approved the use of prostate-specific antigen (PSA) measurements as part of a screening test for prostate cancer. That changed a decade later.

In 2008, the influential US Preventive Services Task Force advised against PSA screening for men 75 and older. The concern was that doctors were diagnosing and treating too many men whose prostate cancer could progress so slowly that the men would die of something else before it became a problem. The treatments could lead to potential side effects such as incontinence and sexual dysfunction.

In 2012, the USPSTF advised against routine screening for all men.

Then in 2018, the group took the advice further, saying men aged 55 to 69 should make an individual choice about screening after talking to their doctor. The group advised against screening for men aged 70 and over.

“We definitely had a problem with overdiagnosis and overtreatment,” said Dr. Samuel Haywood, a urological oncologist at the Cleveland Clinic. “So the USPSTF changed the guidelines, which resulted in a decrease in screening and incidence. This study suggests that the concerns we had then – that there might be an increase in the development of a disease advanced – could have been right.

Changes to the USPSTF guidelines posed less of a problem for urologists than for primary care physicians, as the American Urological Association came up with its own guidelines suggesting using PSA to screen men 55-69 with an average risk of prostate cancer, Haywood said. .

It’s likely that primary care physicians who need to screen for a multitude of different cancers weren’t checking AAU guidelines.

“We think some men weren’t being screened,” Haywood said, adding that it’s possible some of those men are now being diagnosed with advanced cancer.

The solution is not to go back to the days when men with slow-growing cancers received treatments that harmed their quality of life, Tewari said.

“We need to be smarter about using imaging, we need to minimize the number of biopsies, we need to recruit more patients for active surveillance and work together to minimize this trend of more deaths and possibly more metastatic disease at the time of diagnosis,” he said.

The good news is that “there have been dramatic advances in treatments, even for people with advanced cancers,” said Dr. Hank Ng, clinical assistant professor at NYU Langone Health who specializes in medical oncology. “Even those with advanced cancers live for years.”

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