Breaking news: Prostate cancer on the rise again, American Cancer Society

But is the American Cancer Society underestimating death and incidence rates?

By Howard Wolinsky

The American Cancer Society’s just-released annual report shows some good news for cancer. But the glaring exception is prostate cancer.

There was a 3% annual increase in prostate cancer incidence from 2014-2019 after two decades of declines, translating to an additional 99,000 new cases.

But a support group founder suggests ACS is underestimating the toll of prostate cancer.

The new data appear in ACS’s 2023 annual report, accessible at https://www.cancer.org/research/cancer-facts-statistics.html

(Source: American Cancer Society)

But the prostate cancer news is especially grim and even may be worse.

ACS predicts there will be 288,300 new cases of prostate cancer in 2023.

Prostate cancer remains the most common solid cancer in men.

There are 34,700 prostate cancer deaths predicted for 2023.

Prostate cancer is the second leading cause of cancer deaths in men.

"Most concerning is that this [prostate cancer] increase was driven by the diagnosis of advanced disease," said ACS CEO Karen E. Knudsen, MBA, Ph.D., noting that the highest incidence and death rates were among black men.

But Rick Davis, a PCa patient and founder of the AnCan, a leading support group, said: “The prostate cancer numbers are far worse than ACS is spinning. AnCan agrees with and endorses the 2023 estimate, or 288,000 new diagnoses in 2023, however, that is a 65% increase over 2019 at an increase of over 16% per annum.

“Why are we talking three percent [increase incidence] here? As for the estimated PCa-specific deaths, we feel they are way underestimated. Numbers can no longer be five-year lagged to predict death rates. With some 20% of new diagnoses de novo metastatic, many of these men don't make it that long. 34,700 looks significantly low."

Davis feels the ACS’ 2023 incidence figures masks what has really happened since then.

He lists ACS’s annual estimates of cases in more recent years:

2019   174,650

2020   191,930

2021   248,530

2022   268,490

2023   288,300

“That's a whopping 16% per annum (+65.1% overall)!!!” he said in an email.

He said the estimates understate the deaths since deaths of patients from advanced PCa often are reported to vital statistics offices as pneumonia, heart attacks, and other conditions.

As for the estimated prostate deaths, he lists ACS’s own numbers for more recent years:

2019   31,620

2020   33,330

2021   34,130

2022   34,500

2023   34,700

“That's an 11% increase over the period of 2014-2019, or just 2.8% per year. That is way underestimated and a scandal,” said Davis.

“I expect ACS will say that deaths are lagged five years BUT with the enormous increase in late Dx [diagnoses] many men are not making it five years (we see them in support groups) and [ACS’s] old model is no longer accurate.”

He said there are similar defects in the number of breast cancer deaths.

ACS did not respond to a request for comment,

Many urologists and patient advocates blame the increase in prostate cancer cases, with many aggressive cancers being diagnosed very late, on the U.S. Preventive Services Task Force (USPSTF) policies recommending against prostate-specific antigen (PSA) testing starting in 2012 when it slammed PSAs with a D-Grade and again in 2018, with a revised C-Grade, after howls from critics, when it concluded the decision on whether to do a PSA was a matter of discussion between patient and doctor.

Hardly a ringing endorsement.

USPSTF, which advises primary care doctors on screening, aimed to put a dent in the epidemic of overdiagnosis and overtreatment of prostate cancer, resulting in unnecessary aggressive treatment with such side effects as impotence and incontinence. (Click for task force recommendations.)

Dr. William Catalona, Northwestern University (Go Cats!) Geinberg School of Medicine, “the father of PSA screening,” told me recently that the best PSA rates he’s heard of were as high as 73% in men in their 50s and 60s in Ontario in 2011/12. “But this estimate is unrealistically high,” he conceded.

He pointed to a more realistic study of patients in the Veterans Health Administration, America’s largest integrated healthcare system, that found that PSA screening has dropped from 47% in 2005 (pre-USPSTF D rating) to 37% in 2019 (a year after the latest USPSTF C grade).

I just reported that the University of Chicago research group NORC found that screening for prostate cancer may be the most successful of screening approaches. Check out NORC numbers on those who undergo screening.

NORC reports that 77% of prostate cancers are found through screening. Compare that to percentages for other cancers found through screening: 61% of breast cancers, 52% of cervical cancers, 45% of colorectal cancers, and a super-low 3% of lung cancers.

We need to find ways to get persuade more men to undergo PSA screening to find aggressive prostate cancers.

With the addition of MRI scanning these days, the risks are reduced somewhat for overdiagnosis and overtreatment of low-risk prostate cancers.

ACS CEO Knudsen announced a new initiative called IMPACT: Improving Mortality from Prostate Cancer Together, to "mobilize resources across advocacy, patient support and research.”

ACS chief scientific officer William Dahut, MD, said, "IMPACT will fund bold new cancer research programs that connect the laboratory, the clinic, and the community…to help discern who is most at risk for prostate cancer, and how to prevent it."

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Some good news from ACS

The American Cancer Society (ACS) offered up some good news for 2023.

Cervical cancer has declined 65% from 2012 through 2019 among women in their early 20s, the first group to receive the human papillomavirus vaccine. ACS said.

Rebecca L. Siegel, MPH, a cancer epidemiologist and senior scientific director of Surveillance Research at the American Cancer Society, said in the CA: A Cancer Journal for Clinicians that this “foreshadows steep reductions in the burden of human papillomavirus-associated cancers, the majority of which occur in women.”

There also was good news overall.

Siegel said: Despite the pandemic, and in contrast with other leading causes of death, the cancer death rate continued to decline from 2019 to 2020 (by 1.5%), contributing to a 33% overall reduction since 1991 and an estimated 3.8 million deaths averted. This progress increasingly reflects advances in treatment, which are particularly evident in the rapid declines in mortality (approximately 2% annually during 2016 through 2020) for leukemia, melanoma, and kidney cancer, despite stable/increasing incidence, and accelerated declines for lung cancer.

“In summary, although cancer mortality rates continue to decline, future progress may be attenuated by rising incidence for breast, prostate, and uterine corpus cancers, which also happen to have the largest racial disparities in mortality.”

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AS pioneers featured in two free webinars

By Howard Wolinsky

Time to register for two free webinars on active surveillance with two prophets in the land of prostate cancer.

Active Surveillance Patients International (ASPI) and AnCan Virtual Support Group for Patients on Active Surveillance are both holding seminars within two days of each other, Jan. 28 and Jan. 30, respectively.

ASPI first presents the latest episode in the cliff-hanging AS 101 video series, featuring Dr. Laurence Klotz, “father of AS.” Active Surveillance Patients International (ASPI) will premier AS 101 Episode 3 video on Saturday, Jan. 28, 2023, at 12-1:30 p.m. Eastern. To register, click here.

AnCan is featuring Dr. Mark Scholz, co-author of the groundbreaking “Invasion of the Prostate Snatchers.”

Scholz’s program is entitled, "Invasion of the Prostate Snatchers: The return 13 years later. An evening with Dr. Mark Scholz." To register, click here.

In both cases, if you can’t make it, register and you’ll get a link to the recording.

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If you want to hear my AS origin story, check out the video on Prostate Cancer Research Institute’s website:

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