Prostate Cancer Diagnoses Decline Worldwide, But Prostate Health Still Worrisome

May 4, 2019

Prostate Cancer

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A recent study reported on the global decline in prostate cancer diagnoses, which sounds like great news. Indeed, the data from five continents and covering up to 32 years showed that in many areas of the world, prostate cancer diagnoses and deaths had decreased or stabilized.

The experts worked with data provided by the following sources:

  • 38 countries that provided accurate, timely, and complete information long-term, for 1980 through 2012
  • 44 countries that provided incidence data (prostate cancer diagnoses) from a five-year period (mostly 2008-2012)
  • 71 countries that provided mortality data from a five-year period (mostly 2008-2012)

Here’s what the study’s authors found when they evaluated the data:

  • Prostate cancer diagnosis rates declined from 2008 to 2012 in at least seven countries
  • During that time period, the United States had the greatest decline in prostate cancer diagnoses
  • Prostate cancer diagnosis rates stabilized in 33 countries

If you look at just the headlines or these selected findings, it sounds like a time for celebration.

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The hard facts about prostate cancer diagnoses and deaths

But the results of this study are a far cry from saying we are winning the battle against a disease that is the second most commonly occurring cancer in men. The hard facts still remain:

  • One in nine men will be diagnosed with the disease during their lifetime
  • In 2018, a total of 3 million new cases of prostate cancer were diagnosed
  • In the United States, the American Cancer Society’s estimates for new cases of and deaths from prostate cancer in 2019 are 174,650 and 31,620, respectively. About one man in 41 will die of the disease.
  • As of 2012, prostate cancer has been the number one male cancer diagnosis in 96 countries and the number one cause of death among males in 51 countries

None of these statistics sound like a reason for complacency.

Concerns about prostate cancer PSA screening

A number of issues surrounding prostate cancer and prostate health are especially worrisome, both in the United States and around the world. One area of concern is the PSA (prostate-specific antigen) screening test. Use of this screening method is controversial because it is neither an accurate nor an effective way to detect prostate cancer. Although there are numerous other prostate cancer tests in the pipeline and under development, for now the main screening tool is the PSA test.

Many men are confused about whether they should undergo PSA screening or not. One example of this confusion was revealed in a 2018 study appearing in Health Equity. In that study, the authors noted a decline in PSA screening from 2010 through 2014, with the biggest drop in 2012.

The decreased numbers of PSA screenings were seen in urban hospitals around the time (2012) the US Preventative Services Task Force (USPSTF) recommended against screening. The USPSTF guidelines were in contrast to the American Cancer Society’s recommendation that men 50 and older should undergo screening, and that men at high risk should be screened even earlier.

It should be noted, however, that the USPSTF revised their guidelines in 2018 to state that the decision to choose PSA screening should be an individual decision reached after discussion between a man and his healthcare provider.

The American Urological Association also has its own screening guidelines. It recommends no screening for men younger than 40, no routine screening for men between 40 and 54 unless they are at higher risk (e.g., African Americans or family history), and screening for men ages 55 to 69 after individually weighing the benefits and risks and based on a man’s values and preferences.

Prostate cancer diagnoses and African Americans

Although the United States was found to have the greatest decline in prostate cancer diagnoses in the study, numbers are not declining for African American men. Compared with whites and other men of color, one in six African American men will develop the disease during their lifetime. They also are 1.7 times more likely to receive a diagnosis and 2.3 times more likely to die from prostate cancer than are white men.

In addition, the study found that the countries with the highest mortality rates from prostate cancer included many countries with black populations, including Barbados, Trinidad, Tobago, and South Africa. Research is needed to determine why these men of color are at such high risk of death from this disease.

When it comes to clinical trials, African Americans are typically not adequately represented. Several hurdles seem to be responsible for this, including doctors not asking patients to join clinical trials, many African American men don’t seek medical care until later in their cancer stage, financial limitations (transportation to and from studies, time off from work), and no access to local cancer centers where trials are taking place.

Promoting prostate health

Overall, there is still a stigma about prostate health. Although more and more men are learning about and appreciating the importance of taking care of their prostate health, we still have a long way to go. Embarrassment, machismo, lack of education about the gland’s importance, no support systems, and unavailability of resources are still holding back many men from taking care of this tiny yet important gland.

Many of the tactics recommended to support and preserve prostate health are also those recommended for overall health. A clean, nutritious diet, adequate sleep, regular exercise, stress reduction, limited or avoidance of alcohol, and no smoking are all included. However, convincing men to talk to a medical professional about prostate cancer screening or any symptoms they may be experiencing regarding their prostate (e.g., urinary frequency, urinary urgency, dribbling, pelvic pain, excessive urination at night, pain during urination) is another matter.

The medical community need to make seeking health advice comfortable, convenient, and affordable in all countries. Culturally sensitive information must be provided for men so they will be more likely to respond. One such effort can be seen in the United States where various initiatives around the country are bringing prostate cancer information and screening to African American men in environments that are safe for them: barber shops.

The fight against prostate cancer is raging, but it is far from over.

References

African Americans and prostate cancer. Zero, the end of prostate cancer.

American Association for Cancer Research. Prostate cancer incidence and mortality have declined in most countries. Eurekalert 2019 Apr 2

American Cancer Society. American Cancer Society recommendations for prostate cancer early detection

American Urological Association. Early detection of prostate cancer (2018).

Grady D. In cancer trials, minorities face extra hurdles. New York Times 2016 Dec 23

Patel NH et al. Prostate cancer screening trends after United States Preventative Services Task Force guidelines in an underserved population. Health Equity 2018; 2(1): 55-61

World Cancer Research Fund. Prostate cancer statistics

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