Prostate cancer rates are increasing in the United States, with more men being diagnosed at later stages when the disease is harder to treat, researchers report.
The analysis, published Tuesday in the journal CA: A Cancer Journal for Clinicians, suggests that fewer men are being screened for the disease.
Study co-author Dr. Bill Dahut, chief scientific officer of the American Cancer Society, told The New York Times: “The pendulum may have swung too far in one direction, where we were afraid of overtreatment.”
He added: “Now we’re not finding these cancers early on, when they can be treated and are more curable, and we’re more likely to find metastatic disease that is not curable.”
Changes in Screening Guidelines
In 2012, the U.S. Preventive Services Task Force stopped recommending routine PSA blood tests for prostate cancer due to concerns about overtreatment and side effects like incontinence and impotence, The Times reported.
Following that decision, prostate cancer diagnoses dropped by 6.4% annually from 2007 to 2014. However, starting in 2014, new cases began rising 3% per year.
Diagnoses of advanced-stage disease also climbed 4.6% to 4.8% annually from 2017 to 2021, while localized disease decreased.
In 2018, the task force updated its guidelines, advising that men ages 55 to 69 should make screening decisions individually. The guidelines recommend against testing after age 70.
Expert Concerns
Some doctors now question that approach, as men are living longer and may still benefit from treatment later in life.
Dr. William Oh, director of precision medicine at Yale Cancer Center, told The Times: “Have we abandoned a good strategy, the P.S.A. strategy, and thrown the baby out with the bath water? That is my concern.”
Racial Disparities
The report also highlights significant racial disparities. Black men develop prostate cancer 67% more often than white men and die at twice the rate. Native Americans also die at higher rates despite lower incidence of the disease.
Access to care plays a major role. In a study of patients treated at the Department of Veterans Affairs, where care is equal, Black men did not have more aggressive cancers and had slightly higher survival rates compared to white men, The Times reported.
Key Statistics
The American Cancer Society (ACS) highlights that:
- Prostate cancer is the most common cancer in U.S. men
- It is second only to lung cancer as a cause of cancer death among men
- About 1 in 8 men will develop prostate cancer in their lifetime
Looking Forward
Experts say more research is needed to understand why rates of advanced-stage prostate cancer are climbing, although improved imaging and possible environmental factors may play a role.
The ACS recommends men discuss screening with their doctors starting at age 50. Black men and those with a family history of prostate cancer should start the conversation at age 45, and some experts suggest even earlier testing for those who may have higher risk.
This report underscores the ongoing challenge of balancing the benefits of early detection against the risks of overtreatment, while highlighting the urgent need to address racial disparities in prostate cancer outcomes.