In March, 2021 COVID-19 was named as the third leading cause of the death in the U.S. behind heart disease and cancer. In 2020, it was estimated that there were 191,930 new cases of prostate cancer (PCa), with an expected 33,330 men dying from the disease.

We know that of all cancers, lung cancer is statistically the deadliest, as the leading cause of cancer death. However, the numbers are changing. For one thing, as fewer people smoke, the incidence of lung cancer is dropping. For another, cancer patients are living longer with their disease thanks to better understanding of cancer and advances in treatment. According to the American Cancer Society, “The death rate from cancer in the US declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop ever recorded, according to annual statistics reporting from the American Cancer Society.”

A research team out of MD Anderson Cancer Center and two other organizations took on the challenge of working with shifting demographics and cancer data to project disease incidence and death out to the year 2040. What they found will be “marked changes in the landscape of cancer…”^[i] Based on projected average annual percentage changes (AAPC), they predict the most common cancers will be

1. Breast
2. Melanoma
3. Lung
4. Colorectal

While the leading causes of cancer death will be

1. Lung
2. Pancreatic
3. Liver/intrahepatic bile duct
4. Colorectal
5. Breast

The future of PCa?

If the number-crunching is on target, you will notice that PCa is not on either list among the top four or five. In fact, the study suggests that based on AAPC it will drop to the fourteenth most common cancer (total population of males and females combined). For males, compared to 2020 the top cancer sites in 2040 changed to melanoma (127,000 cases), lung (93,000 cases), bladder (77,000 cases), kidney (76,000 cases), and colorectal (75,000 cases). The authors note that these numbers “reflect the incorporation of known changes in incidence rates over time.”

Why the drop in PCa? According to the team, it’s based on “decades-long observed incident rate trends.” This means that the incidence of PCa has already been diminishing. While it might be tempting to peg it to the beginning of the PSA screening era in the mid-1990s, it would be more accurate to attribute the drop in PCa deaths to that historic event, not the incidence of PCa itself. The ability to detect PCa before it had left the gland, and better diagnostics (including genomics) means that fewer men than ever die from this cancer.

However, if fewer men are being diagnosed with PCa, it seems two key factors are at play:

• First, the drop in broad PSA screening means fewer men being sent for biopsies. While many experts believe the U.S. Preventive Services Task Force against wide screening was unwise, it is a fact that whether or not to have a PSA test is now frequently left to a discussion between an individual patient and his doctor. Thus, a lower incidence of PCa may be an artifact of a shift in thinking against routine PSA testing.
• Second, there’s been an uptick in men’s health awareness. Though still not prevalent among minorities and lower income groups, consciousness is growing that nutrition, exercise and other lifestyle choices reduce the likelihood of PCa (and other life-shortening conditions like obesity, diabetes, chronic inflammation, etc.)

At the Sperling Prostate Center, we are actively pro-prevention when it comes to PCa. I like to believe that our interactions with our patients support wellness choices that transcend PCa alone. Our blogs contain up-to-date, research-based information on how to reduce the chances of developing PCa, and how to raise the probability of a long and healthy life.

In fact, we would love to see the day when we have to close up shop because there’s no more PCa. Well, if the article is correct, it will still be around in 2040—but dropping to the fourteenth place in most common cancers is news we would certainly welcome!

We strongly encourage men to have an annual PSA test from age 45 onward (earlier if there are known risk factors) until a more specific and economic biomarker is developed. And, if a PSA is high or rising, follow it up with a noninvasive multiparametric MRI on a 3T magnet. We hope that our readers are not among the 1 in 9 men expected to receive a diagnosis of PCa in their lifetime, but with today’s early diagnosis and improved treatments, life can be long and full.

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] Rahib L, Wehner MR, Matrisian LM et al. Estimated Projection of US Cancer Incidence and Death to 2040. JAMA Netw Open. 2021;4(4):e214708.