Prostate cancer should not be a death sentence. But for a shocking number of American men, it is

Since 2014, diagnoses of prostate cancer in the US — which are survivable if caught early — have risen 3% annually. Advanced-stage diagnoses are up 5% year over year.

Adding insult to injury, experts say, black men are being diagnosed late at two to three times the rate of white men, and are nearly 2.5 times more likely to die from it.

It’s a reality that has experts like Karen Knudsen, CEO of the American Cancer Society, “singing alarm bells across the country.”

The deaths and disparities are sad enough. Even more tragic, tens of thousands of American men die each year from a condition that has a nearly 100% survival rate when detected early. One key driver, according to experts: Confusion surrounding screening guidelines issued by a medical task force in 2012 — despite the fact that the controversial recommendations were revised several years later.

As Knudsen points out, “The second leading cause of cancer death for men is a very survivable cancer.”

US prostate cancer statistics “are telling us something,” she says: “We’re not finding it early enough.”

reason behind the rise

In the early 1990s, the US Food and Drug Administration approved a test called the PSA- or prostate-specific antigen test for early detection of prostate cancer. A simple blood draw detects a protein produced by cells in the prostate gland, an increase in which often indicates prostate cancer. After approval, prostate cancer diagnosis rates began to rise rapidly.

However, PSA levels are not raised only by prostate cancer. Benign factors such as infection or stimulation from biking or vigorous sexual activity can also cause growths, according to oncologist Dr. Bilal Siddiqui of the MD Anderson Cancer Center at the University of Texas.

Inevitably, artificially elevated PSA levels result in unnecessary biopsies—and, with them, undesirable side effects such as incontinence, anxiety, and erectile dysfunction in some. Concerned that the blood test was doing more harm than good, in 2012 the US Preventive Services Taskforce changed its guidelines to recommend against its use for prostate cancer screening.

Two years later, a steady increase in prostate cancer diagnosis rates began.

“Sometimes when you throw out the baby with the bathwater, you have unintended consequences,” Dr. William Oh—an oncologist and professor at the Icahn School of Medicine at Mount Sinai in New York and chief medical officer of the Prostate Cancer Foundation—says Luck.

The 2012 recommendation — or reverse recommendation, of sorts — “created confusion in the minds of men, but also primary care providers,” says Knudsen. While the task force updated its recommendation again in 2018 — to suggest that men between the ages of 55 and 69 should discuss screening with their doctor, weighing the risks and benefits — the disadvantages, obviously. , it was done.

More than a decade after the initial recommendation, advances in imaging have reduced unnecessary biopsies, Knudsen says. And prostate cancer screening is safe and easy with “no inherent harm.”

Now there’s no reason No To start a conversation with one’s doctor about it, he says, especially for men 50 and older, and those with a family history or known genetic risk of prostate cancer.

“No one should wait until they have symptoms to get a prostate exam,” she says. “It’s simple and a forum for an important discussion with a physician.”

‘Watchful waiting’ is an option for many patients

Experts say not all prostate cancer is the same—and that’s good news for men with the condition. Many prostate cancer patients have “relatively low-grade disease” that hasn’t spread beyond the prostate, and treatment may involve “watchful waiting,” Knudsen says.

Men who catch their prostate cancer early are no more likely to die, statistics show. In fact, studies have shown that 50% of men autopsied die Together “Prostate cancer, but not by position,” says Siddiqui, “indicates that,” to some degree, “certain cellular changes along the spectrum of prostate cancer” may actually be a normal part of the aging process.

“There are prostate cancers that will never be fatal in a man’s lifetime,” advises Oh. “As you get older, some men—many men—will have a small amount of prostate cancer in their prostate. The goal with those men is not to treat them if they don’t need it. These men Isolation and active surveillance are very important.”

Such patients stand in contrast to men with a family history of the disease and/or those who have genetic risk factors, who often suffer more aggressive disease. Harmful mutations on the BRCA1 and BRCA2 genes may also confer a higher risk of prostate cancer, experts say, despite movie star Angelina Jolie being famous for promoting breast and ovarian cancer. According to an article published in 2022, people with this type of change in BRCA1 have an estimated 30% risk of developing prostate cancer in their lifetime. Journal of the National Cancer Institute, This risk rises to 60% among carriers of a BRCA2 mutation.

Treatment options for high-risk, sensitive patients include radiation and surgery—and such patients should be treated “as aggressively as possible,” says Oh.

People tend to think of prostate cancer as one condition, and that’s not true at all, argues Oh. As Knudson says, cancer as a whole has more than 200 different diseases, and even prostate cancer cases can be divided into groups, or classified on a spectrum.

A young patient with “aggressive-looking” prostate cancer whose father had the condition and who carries a BRCA2 mutation is “a completely different patient than an 80-year-old man who does a biopsy and shows very low-grade, slow progression.” “prostate cancer,” advises Oh.

“Those two individuals couldn’t be more different,” he said, “and their treatment should be vastly different as well.”

what to watch, and when to act

According to the US Centers for Disease Control and Prevention, the symptoms of prostate cancer can vary widely, and some patients do not show symptoms at all. However, the following symptoms can be telltale signs:

• difficulty urinating
• weak urine stream, or interrupted flow
• frequent urination
• trouble emptying the bladder completely
• pain or burning when urinating
• blood or semen in the urine
• back, hip and/or pelvic pain that does not get better
• painful ejaculation

Patients diagnosed in the early stages of the condition “can have a high expectation of cure,” says Knudson, “and can continue to have a wonderful quality of life.” In fact, the five-year survival rate for prostate cancer is nearly 100%, says Siddiqui.

The outlook for late-diagnosed patients, however, is not nearly as rosy. There is no “durable cure” for this type of cancer, Knudsen explains. The five-year survival rate for advanced prostate cancer is only 31%, according to Siddiqui.

When it comes to prostate cancer prevention, Oh advises, “What’s good for your heart is good for your prostate.” He encourages men to pack their diets full of leafy green vegetables and colorful fruits, and to limit dairy and barbecued meats, which have been linked to a higher risk of prostate cancer and aggressive prostate cancer.

“Exercise is also associated with a favorable outcome,” he adds.

And when it comes to detection? Once men are in their 40s — or earlier if they are black, have a family history of cancer, or have a genetic mutation linked to prostate cancer — OH recommends that they talk to their primary care about screening. Talk to the provider or urologist. The conversation should happen every year or two.

“Doctors are very busy and have different feelings about everything, really — especially in the area of ​​cancer screening,” he says. “Unfortunately, cancer screening is more controversial than it should be. Guidelines change quite often, and differ from organization to organization. It can be hard for the average person to know what to do.”

If you don’t feel heard when you talk to your doctor, get a second opinion, he recommends.

Adds Oh: “Early detection of a bad disease is always better.”