Good news, bad news for prostate cancer
American Cancer Society's annual report has good news for localized prostate cancer
Good news, bad news on prostate cancer.
First, the good news, cases of localized prostate cancer--confined to capsule--are holding steady, according to the American Cancer Society (ACS).
Now the bad news. Cases of more advanced prostate cancer are on the rise. And deaths from prostate cancer are still declining but at a slower rate,
The American Cancer Society always rings in the new year with estimates of new cases and deaths for cancer.
I’ve been following these numbers since I started as the medical reporter for the Chicago Sun-Times in 1981. (FYI. my first story for the paper was the medical angles of the assassination attempt on President Ronald Reagan. I got the front page and OT.))
There’s good news for cancer overall. Death rates continue to fall for both men and women. For cancer confined to the prostate or the region around it at diagnosis, five-year survival rates remain close to 100%.
Rates for prostate cancer had been a good news story, though some of that may be attributed to statistical distortions from the 1990s as the prostate-specific antigen (PSA) test became common and an apparent “epidemic” of prostate cancer rolled out followed by a decline in rates,
The risk of dying from prostate cancer decreased by about 50% from the mid-1990s to the mid-2010s due to improved treatment and earlier detection through screening with prostate-specific antigen (PSA) testing, which helps find cancer when it is only in the prostate (localized). “But in recent years, the risk of dying from prostate cancer is only decreasing by 0.6% a year. The cause for this slowing progress may be related to changes in screening guidelines,” according to Rebecca Siegel, MPH, lead author of Cancer Statistics, 2022, and Senior Scientific Director of Surveillance Research at the American Cancer Society.
Things changed again after the U.S, Preventive Services Task Force, which guides primary care physicians, gave a poor rating to the PSA in 2012 and use of the test fell off and advanced cancer rates shot up. The task force reversed itself in 2018 with the idea of doctors and patients sharing decision-making about PSA testing. (Primary care doctors order about 90% of PSA tests.)
In 2021, there were an estimated 248,530 new cases of prostate cancer and 34,130 deaths. In 2022, there will be an estimated 268,490 new cases and 34,500 deaths, according to the American Cancer Society.
So, cases will have increased an estimated 19,960, or about 8%. (Note this is based on modeling. The latest hard numbers were collected in 2019.) Deaths from prostate cancer are not declining as steeply as they did in the past.
Siegel said, “Changes in prostate cancer incidence rates largely reflect screening with the PSA blood test,
which mostly detects localized-stage disease. After declining during the late 2000s and early 2010s because of changes in screening guidelines followed by less PSA testing, rates from 2014 to 2018 were stable overall and for localized-stage disease, but increased by 4% to 6% annually for advanced-stage cancers.”
Prostate cancer death rates declined by about half from the mid-1990s to the mid-2010s due to earlier detection through PSA testing and advances in treatment. However, the decline has slowed in recent years, likely reflecting the uptick in distant-stage diagnoses; from 2015 to 2019, the rate decreased by 0.6% per year.
As a result, the proportion of prostate cancers diagnosed at a distant stage has more than doubled over the past 10 years, from 3.9% to 8.2%.
ACS researchers note that “controversy remains about the underutilized potential of the PSA test” to reduce deaths from prostate cancer by detecting potentially fatal disease earlier.
Take a breath. Guys (like most who will read this) with low-risk Gleason 6 prostate “cancer”--many don't consider Gleason 6 lesions as a real cancer-- are far more likely to die from heart disease. Experts say that Gleason 6 looks like cancer but don’t act like it, and that virtually never spreads. You’re more likely to die from heart disease. So start working on that. Remember, too, only about 3% of men diagnosed with prostate cancer will die from it.
Note: Because of the defects with PSA testing, an epidemic of overdiagnosis and overtreatment emerged, With many men with Gleason 6 undergoing unnecessary “definitive” treatments, including radical prostatectomies and radiotherapy that carry such risks as impotence and incontinence. That’s why active surveillance with close monitoring was developed by Drs. Klotz, Carroll, and Carter.
Charles Ryan, MD, CEO of the Prostate Cancer Foundation, which focuses on researching treatments to help men with advanced cancers, found the silver lining in the ACS report: “Death rates for cancer overall continue to decline for both men and women. For prostate cancer that is confined to the prostate or the region around it at diagnosis, five-year survival rates remain close to 100%.” Not new but the good news with low-risk and favorable intermediate-risk prostate cancer.
Ryan added: “However, the report also reveals that the death rate from prostate cancer is no longer declining as quickly. (The) the main reason is that more men are being diagnosed at an advanced stage: during 2014-2018, the rate of diagnosis of advanced cancer increased by 4%-6% per year. For these patients, the 5-year survival rate is only 31%. New treatments do extend the lives of men with advanced disease, but the key to a successful outcome is early detection and shared decision-making between patients and doctors regarding treatment. We want to see rapid progress in this fight, rather than a ‘flattening’ in the downward trend.”
ACS researchers note that “controversy remains about the underutilized potential of the PSA test” to reduce deaths from prostate cancer by detecting potentially fatal disease earlier.
News for Black men isn’t good.
“One study found that after the 2012 USPSTF guideline changes, there was a steeper drop in PSA testing in Black men than in White men,” said Siegel. “That’s concerning because early detection is especially important for Black men, who are twice as likely to die from prostate cancer as White men.” See the ACS Guidelines for Screening and Early Detection of Prostate Cancer.
Ryan said, “The disparities in prostate cancer incidence and death between non-Hispanic Black and white men remain unacceptably high. Black men are about 75% more likely to be diagnosed with prostate cancer, and over twice as likely to die of the disease. The pandemic also affected prostate cancer screening and care. The downstream effect of millions of missed cancer screenings may not become evident for years.”
Meanwhile, would you consider delaying radical surgery if your cancer progresses? Take the Quick Quiz.