High-risk prostate cancer seems to be on the rise. Experts are debating the reasons for this alarming development.
Have Prostate Cancer Diagnoses Changed?
A new study found a 72 percent increase in metastatic disease between 2004 and 2011. Men between 55 and 69 years of age experienced a 92 percent increase in new cases of advanced prostate cancer over the last decade. Low-risk prostate cancer cases were down 37 percent.
Did the USPSTF Recommendations Make the Difference?
In 2011 and 2012, the United States Preventive Services Task Force recommended that doctors not run PSA tests on every man. The PSA, or prostate-specific antigen, may be specific to prostate but not to prostate cancer. Epidemiological studies don’t show that PSA screening saves lives (New England Journal of Medicine, March 15, 2012).
Urologists have worried that less PSA screening could lead to more men being diagnosed at later stages. That is one possible explanation for the current finding on high-risk prostate cancer.
The researchers reviewed the medical records of over 760,000 men with prostate cancer. The researchers are uncertain whether the changes in aggressive prostate cancer are due to less vigilant screening of men without symptoms or to other unidentified factors that increase the likelihood of metastases.
Changes in PSA:
The rise in metastatic disease actually began before the USPSTF recommendations changed screening practice. Men diagnosed with prostate cancer metastases also had significantly higher PSA levels on average. The median PSA of those diagnosed in 2004 was 25.5 ng/ml. This nearly doubled to 49.7 ng/ml in 2013.
The authors suggest that there may be biological factors driving prostate cancer to be more aggressive. No one seems to know what those may be.
What Should Men Do?
The current guidelines about PSA screening remain controversial. In light of the new data, men should talk to their physicians about whether increased vigilance is appropriate. Those between 55 and 69 could benefit most from treatment of high-risk prostate cancer. A man with a family history of prostate cancer may benefit from starting screening earlier than others. In addition, any symptoms should be brought to the doctor’s attention promptly.
Prostate Cancer and Prostatic Diseases, online July 19, 2016
Criticism of This Study:
A number of cancer experts, including Otis Brawley, MD, head of the American Cancer Society, have criticized this study. The researchers did not look at the rate of prostate cancer diagnoses, as epidemiologists would have done, but at the total number of men in the database. It may still be the case that metastatic disease is becoming more common, but the study described above is not capable of determining that. We will need to wait for further studies to clarify the situation. Meanwhile, the advice for men remains the same: talk with your doctor about whether and when you might need to be screened.
