Good News Overall, Complicated for Prostate Cancer

Every year, the American Cancer Society releases new estimates on cancer cases and deaths in the U.S. The report in the journal CA: A Cancer Journal for Clinicians contained some excellent news: the cancer death rate has fallen continuously from 1991 to 2017, with a 29% overall decline. This means that 2.9 million fewer people have died from cancer than if the death rates had remained at their highest prior to this period. In addition, the rate dropped 2.2% from 2016 to 2017, the largest drop ever reported. These reductions stem primarily from long-term declines in death rates for four major cancers: lung, colorectal, prostate, and breast.

However, when looking at recent prostate cancer data, the statistics become more complicated. From 1993 to 2017, the prostate cancer death rate dropped by 52%. However, the report also noted that over the last decade, the prostate cancer death rate has stabilized. In Cancer Network, lead author Rebecca L. Siegel, MPH, said, “Improved early detection is needed, especially for prostate cancer. Rapid declines in prostate mortality in previous years have halted, most likely because of rising incidence of metastatic disease diagnoses due to the discontinuation of PSA testing to screen for prostate cancer.”

The background

In 2008 and 2012, the U.S. Preventive Services Task Force released recommendations against routine PSA screening, first for men over 70 and then for all men. “This has led to a dangerous hiatus in PSA testing in many men, and a total lack of PSA testing in many others,” Dr. Catalona said.

Consequently, from 2007 to 2014, there was a steep decline in the number of prostate cancer cases diagnosed in the U.S.

A rise in metastatic prostate cancer

Another study, published in the journal Cancer, looked closely at the recent prostate cancer trends. The report found that from 2010-2015, while fewer men were diagnosed with localized prostate cancer, more men were diagnosed with metastatic disease. Specifically, localized cancer cases decreased from 195.4 to 131.0 per 100,000 men ages 50-74 years; for metastatic prostate cancer, the rates increased from 6.2 to 7.1 per 100,000 men. For men 75 years and older, the incidence per 100,000 men decreased from 189.0 to 123.4 for localized prostate cancer and increased from 16.8 to 22.6 for metastatic disease. “This report illustrates recent prostate cancer ‘reverse migration’ away from indolent disease and toward more aggressive disease beginning in 2012,” the authors wrote.

In 2018, the Task Force revised their recommendations. They now recommend shared decision making regarding PSA screening for men ages 55 to 69 years old. However, they still advise against screening men age 70 and older. Research will continue to assess whether this has an impact on prostate cancer in the U.S., and QUEST will continue to report on these studies as they are published.

Dr. Catalona’s Response

The “dark ages of PSA screening” decade from 2010-2018 has produced an entire generation of primary care physicians and internists who don’t believe in PSA testing. Consequently, we are now seeing many more men being diagnosed with advanced prostate cancer. This failure to order PSA testing pursuant to the guidelines will compromise the greater than 50% decrease in prostate cancer mortality that occurred in the U.S., Canada, and other countries to a lesser degree during the PSA screening area from 1991 to 2010.

2020 U.S. Prostate Cancer Statistics and Estimates

Prostate cancer remains the second leading cause of cancer death in U.S. men; only lung cancer is more deadly. The American Cancer Society estimates that in 2020, 191,930 men will be diagnosed with prostate cancer, and 33,330 men will die from the disease. About 1 man in 9 will be diagnosed with prostate cancer during his lifetime.

Yet, the five-year relative survival rate for prostate cancer is currently high at 98% for all stages of prostate cancer combined. However, the survival rate for men diagnosed with distant stage disease, in which the cancer has spread from the prostate farther into the body such as the lungs, liver, or bones, was only 31%

Prostate cancer is easiest to cure when treated before it spreads from the prostate. The URF supports routine screening for the early detection of prostate cancer.