More men diagnosed with advanced prostate cancer as PSA screening declines


More men are being diagnosed with advanced prostate cancer that is less likely to respond to treatment. According to a new study by the American Cancer Society.

Prostate cancer, the second leading cause of cancer death among men in the U.S., increased 3% annually from 2014 to 2019 after two decades of decline. With the increase driven mostly by advanced disease diagnoses. Researchers reported Thursday in CA: A for Physicians. Cancer Journal.

The study’s lead author, Rebecca Siegel. Senior scientific director of surveillance research at the American Cancer Society. Said the increases are “alarming.” That’s because prostate cancer that has spread to distant sites outside the organ is “extremely difficult to treat,” Siegel said. “There is no durable cure for those with metastatic disease,” he added.

The rise in malignant prostate cancer cases may be partly linked. To recommendations against prostate-specific antigen, or PSA, screening for healthy men, experts suggest.

In the new report, Siegel and his colleagues found that advanced-stage prostate cancer diagnoses. Have increased 4% to 5% annually since 2011.

“In 2019, 8% were diagnosed at a distant stage, compared to 4% in 2011. And 14% were diagnosed at a regional stage, compared to 11% in 2011, for a total of 22% advanced stage,” Siegel told NBC News.

Once prostate cancer has spread far from the original tumor, the prognosis is grim. According to Siegel, the five-year survival rate for this cancer is 32%.

Even more concerning than the increase in advanced cancer diagnoses is the increase in prostate cancer deaths.

In 2017, an estimated 26,730 men died of prostate cancer, with that number expected to rise to about 34,500 in 2022. Said Dr. Ash Tewari, chair of urology at the Icahn School of Medicine at Mount Sinai in New York.

“This increase is alarming and warrants a new look at prostate cancer screening,” Tewari said. “On an annual basis, another 8,000 men died. Basically, it’s like 16 Boeing 747s crashing.”

Black men had a 70% higher incidence of prostate than white men. Prostate cancer death rates are two to four times higher among black men than among men of other racial and ethnic groups, the researchers found.

Decreased prostate cancer screening

In 1994, the Food and Drug Administration approved the use of prostate specific antigen (PSA) measurement. That changed a decade later.

In 2008, the influential US Preventive Services Task Force recommended against PSA screening for men age 75 and older. The concern was that doctors were diagnosing and treating too

many men whose prostate cancer could progress. So slowly that the men would die of something else before it became a problem. Treatment can lead to potential side effects such as incontinence and sexual dysfunction.

In 2012, the USPSTF advised against routine screening for all men.

Then in 2018, the group issued more guidelines, saying that men ages 55 to 69 should make an individual choice. About screening after talking with their doctors. The group advises against screening for men 70 and older.

“Obviously we had problems with overdiagnosis and overtreatment. Said Dr. Samuel Haywood, a staff urologic oncologist at the Cleveland Clinic. “So the USPSTF changed the guidelines and that resulted in decreased screening and incidence.

Changes to the USPSTF guidelines were less of a problem for urologists than for primary care physicians. Because the American Urological Association came up. With its own guidelines that recommend using PSA to screen men ages 55 to 69 who have an average risk of prostate cancer, Haywood said. .


The solution is not to return to the days when men with slow-growing cancers. Were receiving treatments that adversely affected their quality of life, Tewari said.

“We need to be smarter about the use of imaging, we need to reduce the number of biopsies. We need to recruit more patients for active surveillance and work together to reduce this trend of more death at diagnosis. And possibly more metastatic disease,” she said.

The good news is that “there have been tremendous advances in treatment, even for people with advanced,” says Dr. Hank Ng. Aclinical assistant professor at NYU Langone Health who specializes in medical oncology. “Even people with advanced cancer are living for years.

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