The tsunami is coming: Will the whole world finally be watching prostate cancer?

Look at what's up Down Under.

By Howard Wolinsky

Top prostate experts warned last year that a prostate cancer “tsunami” is on the horizon.

An "inevitable" global surge in prostate cancer is coming, with a worldwide doubling of cases to 2.9 million and an 85% increase in deaths to nearly 700,000 by the year 2040, the Lancet Commission on Prostate Cancer warned at a urologists meeting I covered.

In some places, such as the U.K, Australia, and New Zealand, prostate cancer already is the most common solid cancer, as it bypassed breast cancer.

Debate is underway around the world about what to do about it.

The PCa ‘epidemic’

The adoption PSA (prostate-specific antigen ) screening for prostate cancer in the U.S. led to a public health disaster in the 1990s, with overdiagnosis and overtreatment of patients with lower-risk PCa, and at the same time, too many advanced cancers being missed.

The U.S. Preventive Services Task Force, a semi-governmental agency that recommends guidelines for screening, in 2012 agave poor grades to PSA, causing an uproar among patient advocates and urologists. In 2018, the task force, under attack by urologists and atient advocates, recommended that rhat men ages 55 to 69 years discuss the possible benefits and harms of PSA screening with their health care provider and make an individualized decision about whether to get screened.

Advocates have blamed USPTF recommendations for the rise in prostate cancer, especially advanced cases.

The task force is expected soon to release new guidelines. Put your seatbelt on.

Advocacy group for men’s health health draws a bead on PCa

Peter Baker, director of Global Action on Men’s Health, a U.K.-based collaborative on male health, spoke out in an op-ed in The Telegraph, entitled: “Men’s health has been neglected for too long – prostate cancer is a case in point.”

(Peter Baker)

He said: “Prostate cancer is one of the many men’s health issues in urgent need of attention. There have been major advances in treatment over the past 20-30 years but there are still too many blind spots.

“Why do so many men, especially in lower-income countries, lack basic information about the disease? How is it that so little is known about how to prevent prostate cancer? Why are so many men, especially Black men and others at higher risk for genetic reasons, diagnosed when their cancers are already advanced? “

And he asks: “Why is prostate cancer absent from many countries’ national cancer plans?” (See Sidebar.)

In an effort to avoid the PSA-related problems encountered in the U.S., European health agencies and experts traditionally have not been keen on PSA testing. But with advances, such as with MRI testing as a complement, this staring to change.

The European Parliament in 2022 called for early detection of PCa. There is an effort across Europe to adopt PCa screening.

The Parliament’s idea is to expand screening of cancers from breast, cervical and colon to include prostate.

As it stands, Lithuania is the only European country with a screening policy.

PSA Rules, Brittania style

Politicians, patients and advocates lately have been calling for a Churchillian effort to screen British men. Newspaper readers in Britain get a constant diet of articles about prostate cancer and the many celebs there who have been treated, including Elton John, Rod Stewart and Stephen Fry,

A national hero and Olympic champion cyclist Sir Chris Hoy raised the visibility of prostate cancer starting in September 2023 when he announced at age 48 that he had been diagnosed with lethal prostate cancer. He was the son and grandson of prostate cancer patients,

Hundreds of thousands of men were inspired to take a 30-second test for their personal risk for PCa offered by Prostate Cancer UK. Others were inspired to get their PSA tests. And politicians and prostate charities are using his can to call for routine, aggressive PSA testing,

The idea is to test men starting their 40s—though many leading urologists think current guidelines are fine, only recommending screening in the 40s for men with fa amily history like Hoy and men of West African ancestry.

Will Australia lead the way?

Watch out for some innovative policy from OZ. Down Under, there’s a push for the most aggressive national screening guidelines in the world.

The American Cancer Society calls for baseline PSA testing at age 50 for men at average risk for prostate cancer with screening consisting of PSA and possibly digital rectal exams (DRE). ACS recommends baseline testing for higher risk men at ages 40-45.

In Australia, there is a movement for baseline PSAs at age 40.

The National Health and Medical Research Council (NHMRC) plans this August to announce new guidelines that are potentially revolutionary. These include testing younger in men in their 40, expand the upper limit to man over 70, engaging at-risk indigenous men to regular testing, and dumping Digital Rectal Exams (DRE).

Here’s an outline what may be in the works:

• A world-first recommendation to offer a baseline PSA test to interested men at age 40.

• A strong recommendation for GPs to initiate conversations about PSA testing and offer two-yearly testing to all men aged 50–69.

• A reversal of the 2016 stance against testing men over 70, recommending testing based on clinical assessment.

• Earlier and more frequent testing for men at higher risk, including those with a family history or of sub-Saharan ancestry, starting at age 40.

• A recommendation for Aboriginal and Torres Strait Islander men to be tested every two years from age 40, recognising their significantly higher mortality risk.

• Reinforcement that DREs are no longer recommended in primary care, removing a major barrier to testing for many men.

A top physician’s view on what may be coming in Australia

I asked Jeremy Grummet, MD, Deputy Director of Urology at Alfred Health in Melbourne and an international leader in trying to stop transrectal biopsies and its risk for sepsis, explained what’s happening. He said Australia, like most other places, now is not screening for PCa, but rather is “care-finding.”

He said this “is an opportunistic process rather than a structured population-based program, which continues to entrench health inequity by favoring those who are health-literate and disadvantaging those who are not.

“The current case-finding situation is because the harms of PSA testing were thought to outweigh the risks.

“This is no longer the case because a non-invasive Medicare-funded MRI triages who gets a biopsy in Australia. We know that this can reduce unnecessary biopsy by a whopping 50%. {Note: Medicare is Australia’s national universal health plan.]

“Australia also leads the world in the rate of active surveillance of GG1 and some GG2 cancers at over 80%. [Note: Compared to 60% uptake in the U.S., and over 95% in the U.K. and Sweden.]

“So we are not concerned about overdiagnosis.

“On the contrary, we remain very concerned that too many men are being underdiagnosed because they are not being given the opportunity to know their own prostate health risk by a simple blood test.

“Knowledge is power. And it's just a little prick.”

Stay tuned.

World Health Organization called on for comprehensive initiative on PCa

By Howard Wolinsky

In an op-ed, a male health expert called on the World Health Organization to introduce a Global Prostate Cancer Initiative covering every stage of the prostate cancer pathway from prevention to palliative care.

As part of International Men’s Health Week (June 9-15), Peter Baker, director of Global Action on Men’s Health, a U.K. collaborative dedicated to improving the health and wellbeing of men and boys worldwide, also called on governments to create national health plans to detect prostate cancer early.

In an op-ed in the Telegraph, he said: “You may not hear much about it but prostate cancer is the third most common cancer worldwide and the most frequently diagnosed cancer in men in 112 countries. The global incidence of the disease is expected to double by 2040 to almost three million new cases a year – and the mortality rate will increase by 85 per cent.

“These statistics are not just alarming, they are unacceptable. Every effort must be made to slow down and reverse the trend in order to prevent unnecessary suffering among men and their families.”

The WHO initiative Baker envisions includes:

• National governments being urged to introduce prostate cancer policies or national cancer plans which specifically address prostate cancer

• Education and awareness campaigns to provide more accurate information and tackle the stigma many men feel about prostate health

• Early diagnosis is essential. Because early-stage prostate cancer is usually symptomless, as many countries as possible should start planning the introduction of organised national screening programes. Screening could reduce prostate cancer death rates by 35 per cent

• There must be a focus on men at highest risk of poor prostate cancer outcomes, particularly Black men, men with a family history of the disease and men from lower socio-economic groups

• Men with prostate cancer need quick and free (or at least affordable) access to all effective treatment options as well as psychosocial support

• Investments in research, infrastructure, workforce development and treatments are required, especially in lower-income countries where prostate cancer mortality rates are disproportionately high

  

  

  Moto show star Jeremy Clarkson gets his own ‘gear’ checked out— ‘too many friends died from PCa’

  By Howard Wolinsky

  U.K. TV star Jeremy Clarkson, of “Top Gear” and “Clarkson Farm” fame, emphasized the importance of getting his prostate checked out in a column in the Sunday Times.

  The famed moto journo, 65, said: “I’ve had too many friends go down with prostate cancer, and all it takes to get on top of the situation early is a moment or two of being a bit cross-eyed. You get the all-clear and the doc goes home happy. What’s not to like?

  “I went home very happy, because the initial probing and photographing suggests all is well. And let me tell you, nothing makes you feel better than knowing for sure you’re not going to drop dead tomorrow morning.”

  He added: “They can photograph your ventricles and every bit of your brain, but if they want to know what’s going on with your prostate, which lives in the anus, for some reason, the doctor has to put his finger in there. I can only assume it’s because he likes it.”

  Clarkson puts a lot of stock in the digital rectal exam (DRE), which actually has fallen out of favor. He doesn’t mention taking a PSA blood test, the subject of much debate in his homeland.

  He gets into a subject we’ve discussed here before: Celebs in TV and film are required by production companies to undergo physical exams before the “Action!” begins—to protect investments.

  (Check out my take on prostate care and celebs in MedPage Today.)

  Clarkson described these exams as a bit of a sham and how his physician seemed to be in this to drop names of other patients,

  He said: “It is, of course, very exciting when you’re invited to front a television show. But before the cameras can start to roll, the production company’s insurers will insist you have a medical. I guess they don’t want to run the risk of you dropping dead before the expensive filming is finished.

  “However, I’m going to let the underwriters in on a little secret. In my experience, the medical is almost always useless because often, it doesn’t actually happen.”

  “… And as he recently died, I think I can now explain what went on in his surgery, which was: not much. Mainly because he was too busy name-dropping.

  

  “He never actually betrayed any medical secrets. He never said: ‘I had so-and-so in last week and she’s absolutely riddled with genital warts. Never seen anything so revolting since I had to examine so-and-so’s prolapsed anus.’ But he would tell you who’d been there that morning and who was coming that afternoon. And how he was going out that night with Michael Caine.”

  Clarkson prefers to pay for his own medical exams and to see a doctor who doesn’t name drop.

  ASPI webinar June 28: Cracking the Code on Pathology Reports—Helping Patients Navigate Medicalese to Get Better Health Results

  Most patients have a hard time deciphering pathology reports they get after prostate biopsies. At the same time, many are puzzled with their Gleason score.

  Cathryn J. Lapedis, MD, MPH, a Clinical Assistant Professor of Pathology at Michigan Medicine in Ann Arbor, has found in her research that patient-centered reports can help patients understand the reports.

  She will be the featured speaker at the ASPI webinar from noon to 1:30 p.m. on Saturday, June 28.

  Please register for the meeting here.

  Lapedis was the lead author of a recent study in JAMA that found a 93% comprehension of patient-centered pathology reports compared with 39% of those who read a report from the University of Michigan and 56% reading a pathology report from the Veterans Administration.

  She also looked at how these patients interpreted Gleason scores: 84% reading specially prepared patient-centric reports understood their scores vs 48% for the university group and 40% for the VA group.

  She has fellowship training in medical renal and gastrointestinal pathology. Her research centers on rethinking the way pathology results are communicated to patients and the healthcare system. She completed an in-depth analysis of key stakeholders’ attitudes towards patient-pathologist interactions, and is currently piloting early interventions in patient-centered pathology communications.

  Please send questions in advance to: contactus@aspatients.org

  ---