More men were diagnosed with advanced prostate cancer with a lower PSA test

More men are being diagnosed with advanced prostate cancer that is less likely to respond to treatments, a A new study from the American Cancer Society She suggests.

Researchers reported Thursday that prostate cancer, the second leading cause of cancer death in men in the United States, rose 3% annually from 2014 to 2019 after two decades of decline, and that increase was driven mostly by advanced disease diagnoses. Chris: Cancer Journal for Physicians.

The study’s lead author, Rebecca Siegel, senior scientific director for surveillance research at the American Cancer Society, said the increases were “alarming.” This is because prostate cancer that has spread far outside the organ is “very difficult to treat,” Siegel said. “There is no permanent cure for those with metastatic disease,” she added.

Experts suggest that the rise in fatal prostate cancer cases may be related in part to recommendations against prostate-specific antigen, or PSA, screening for healthy men.

In the new report, Siegel and her colleagues found that diagnoses of advanced-stage prostate cancer have increased 4% to 5% per year since 2011.

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

Once prostate cancer has spread far from the original tumor, the prognosis is bleak. The five-year survival rate for these cancers is 32%, according to Siegel.

More alarming than the rise in advanced cancer diagnoses is the increasing number of prostate cancer deaths.

in 2017An estimated 26,730 men died of prostate cancer, while in 2022That number has risen to about 34,500, said Dr. Ash Tiwari, chief of urology at the Icahn School of Medicine at Mount Sinai in New York.

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

Black men have a 70% higher incidence of prostate cancer than white men. The researchers found that death rates from prostate cancer were two to four times higher in black men than in men in every other racial and ethnic group.

Decrease in prostate cancer screening tests

In 1994, the Food and Drug Administration approved prostate-specific antigen (PSA) measurements for use as part of a prostate cancer screening test. That changed a decade later.

In 2008, the influential US Preventive Services Task Force recommended against PSA screening for men 75 and older. The concern was that doctors were diagnosing and treating so many men whose prostate cancer might be progressing so slowly that the men would die of something else before it became a problem. Treatments can lead to potential side effects such as enuresis and impotence.

In 2012, the USPSTF Routine examination is not recommended to all men.

Then in 2018, the group took the guidance even further, saying men ages 55 to 69 should make an individual decision about screening after talking with their doctors. The group advised against screening men 70 and over.

“We certainly had a problem with overdiagnosis and overtreatment,” said Dr. Samuel Haywood, a urologic oncologist at the Cleveland Clinic. So the USPSTF changed the guidelines and that led to a decrease in screening and incidence. This study suggests that the fears we had at the time — that there might be an increase in the progression of advanced disease — may have been valid.”

Changes in the USPSTF guidelines were less of an issue for urologists than primary care physicians because the American Urological Association came up with its own guidelines that suggested using PSA to screen men ages 55 to 69 who have an average risk of developing prostate cancer. .

It is possible that primary care physicians who need to screen a range of different cancers have not checked the AUA guidelines.

“We think some of the men weren’t screened,” Haywood said, adding that it’s possible some of those men have now been diagnosed with advanced cancer.

The solution, Tiwari said, is not to go back to the days when men with slow-growing cancers were given treatments that negatively affected their quality of life.

“We need to get smarter with 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 deaths and potentially more metastatic disease at the time of diagnosis,” he said.

The good news is that “there have been amazing advances in treatments, even for those with advanced cancers,” said Dr. Hank Ng, a clinical assistant professor at NYU Langone Health who specializes in medical oncology. “Even those with advanced cancers live for years.”