It’s hard to avoid bad news these days. It seems like everywhere you turned, someone is trumpeting dark messages about crime, global climate change, new COVID variants, ocean pollution…it’s one warning after another.

Now the American Cancer Society (ACS) has added its own red flag in the area of men’s health. The rate of newly diagnosed advanced prostate cancer (PCa) is increasing for the first time in 20 years, according to Cancer Facts & Figures 2023. The Society’s CEO, Dr. Karen Knudsen, calls this “highly discouraging.” In a Jan. 12, 2023 press release, she goes on to state, “In order to end cancer as we know it, for everyone, it is imperative for us to focus on cancers where trends for incidence and mortality are going in the wrong direction.”

The trend toward more new cases of advanced PCa is indeed moving in the wrong direction. Unlike localized early stage PCa, which has high rates of excellent control when treated early, advanced PCa has already left the gland. If the spread has not left the pelvic bed (adjacent tissues), most patients will be put on androgen deprivation therapy (ADT) to put the brakes on the cancer, and a course of radiation may be recommended in hopes of destroying the disease.

However, if the tumor has spread into regional lymph nodes, and structures beyond the pelvic area such as skeletal locations or other organs, it is called distant metastasis (spread). At that stage, it is considered incurable. When ADT no longer works, the patient will be headed for chemotherapy and/or immunotherapy.

Rates of advanced PCa have increased by 4-5% annually since 2011, and the proportion of men found to have distant spread at the time of diagnosis has doubled during that period.^[i] How is this being accounted for? ACS and other experts point the finger at the U.S. Preventive Services Task Force for backing down on the necessity of broad PSA screening, leaving it up to patient doctor discussion for individual guidance. It happens that the rising rates of advanced PCa coincide with the drop in screening, thus the finger-pointing.

Two aspects of this situation are particularly alarming:

1. Dr. William Dahut, chief scientific officer at ACS, states, “We must address these shifts in prostate cancer, especially in the Black community, since the incidence of prostate cancer in Black men is 70% higher than in White men and prostate cancer mortality rates in Black men are approximately two to four times higher than those in every other racial and ethnic group.”^[ii]
2. Since advanced PCa is more likely to become metastatic, mortality rates due to PCa are expected to rise in the coming years. This will mean increased healthcare expenses to care for more patients with metastatic disease during the time from diagnosis to death, placing a massive economic pressure on a healthcare system already burdened by rising drug/treatment costs, and increased medical needs of a larger percentage of aging people in the population.

The ACS is making every effort to wake all of us up to the coming wave of advanced PCa, and to the healthcare disparities in the population, particularly among Black men compared to White men. The organization, together with its advocacy affiliate American Cancer Society Cancer Action Network (ACS CAN), is mounting an initiative called IMPACT (Improving Mortality from Prostate Cancer Together).

Naturally, it is our hope at the Sperling Prostate Center that the IMPACT program will make a huge difference in correcting the two big problems described above. In the meantime, we continue to provide the earliest possible detection of potential PCa advance through our highly experienced multiparametric MRI (mpMRI) team, recognized as among the top U.S. centers. As one research group describes mpMRI, “It has shown superior performance compared to traditional staging based on clinical nomograms, and provides additional information on the site and extent of disease.”^[iii] The earlier potential spread is identified, the more treatment options are available to stop it in its tracks. In the midst of a world full of bad news, the potential to cure PCa may be the best news for newly diagnosed patients.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Clarke, Hanna. “Rates of prostate cancer are on the rise, new data show.” Urology Times, Jan 17, 2023. https://www.urologytimes.com/view/rates-of-advanced-prostate-cancer-are-on-the-rise-new-data-show
[ii] https://pressroom.cancer.org/FactsandFigures23
[iii] Caglic I, Kovac V, Barrett T. Multiparametric MRI – local staging of prostate cancer and beyond. Radiol Oncol. 2019 May 8;53(2):159-170.