AGI – Prostate cancer cases are estimated to double from 1.4 million per year in 2020 to 2.9 million per year by 2040, with low- and middle-income countries, or LMICs, experiencing more than cases. The alarm was raised by a study by The Lancet Commission on prostate cancer, which will be presented at the Congress of the European Association of Urology.
The number of annual prostate cancer deaths worldwide is projected to increase by 85% over 20 years, from 375,000 deaths in 2020 to nearly 700,000 deaths by 2040. The actual numbers are likely to be much higher of those recorded due to missed diagnoses and data collection opportunities in less developed countries.
Most of these deaths are expected to occur in less developed countries due to rising case numbers and mortality rates. Prostate cancer deaths have declined in most high-income countries, or HICs, since the mid-1990s.
Prostate cancer is already a leading cause of death and disability, accounting for 15% of all male cancers. It is the second leading cause of cancer death in men in the UK and the most common form of male cancer in more than half the world’s countries. The aging population and increasing life expectancy will lead to an increase in the number of elderly men in the coming years. Because major risk factors for prostate cancer, such as age 50 or older and a family history of the disease, are unavoidable, it will not be possible to prevent the impending increase in cases through lifestyle changes or interventions of public health.
“As more and more men around the world live into middle age and old age, there will be an inevitable increase in the number of prostate cancer cases,” said lead author Nick James, a professor of prostate and bladder cancer research at the Institute of Cancer Research in London and consultant clinical oncologist at the Royal Marsden NHS Foundation Trust.
“We know this surge in cases is imminent, so we need to start planning and acting now,” James continued. “Evidence-based interventions, such as improved early detection and education programs, will help save lives and prevent disease caused by prostate cancer for years to come,” James continued.
“This is especially true for low- and middle-income countries, which will bear the majority of future cases,” James added. In high-income countries, prostate cancer screening often involves a PSA test, a blood test that measures levels of a protein called prostate-specific antigen.
However, PSA tests often detect prostate cancer that may not cause symptoms and does not need treatment. The current approach to diagnosing prostate cancer in the UK and many other industrialized countries is based on the ‘informed choice’ PSA test: men aged 50 or over who have no symptoms of the disease can ask their doctor for a PSA test after discussing the risks and benefits.
The Commission says there is evidence to suggest this approach leads to over-testing in older men at lower risk, but does not increase the detection of prostate cancer in younger men at higher risk. Furthermore, the authors point out that there is huge variation in the likelihood of men being diagnosed with advanced prostate cancer with the “informed choice” PSA testing strategy, for example the National Prostate Cancer Audit in the UK found that in 2022, in London, 1 in 8 men, around 12.5%, will be diagnosed with advanced prostate cancer, while in Scotland more than 1 in 3, around 35%, will be diagnosed with this type of cancer late.
The authors recommend using MRI in combination with PSA testing to screen men at high risk for prostate cancer in HICs, such as those with a family history of the disease, those of African descent, and those who are carriers of the disease. BRACA2 mutation. According to the researchers, this approach would reduce over-treatment while also identifying life-threatening disease. MRI is effective in imaging tumors and can be used to provide information about the aggressiveness of the disease and the likelihood of life-threatening conditions.
However, biopsies are better at identifying aggressive tumors, so MRI alone should not be used to investigate men at high risk for the disease. The effectiveness of PSA testing at a population level has not been tested in low-income countries, and there is an urgent need for cancer screening studies in these countries. New approaches to enable earlier diagnosis in less developed countries are vital, as the majority of men in these countries have metastatic cancer, an advanced form of the disease in which the cancer has spread to other parts of the body, often to the bones.
Men with advanced prostate cancer are much less likely to survive long-term than those who are diagnosed early. “With prostate cancer we cannot wait for people to feel unwell and seek help – we must encourage testing in those who feel well but have a high risk of the disease, in order to detect prostate cancer early,” he said. James pointed out.
“Mobile clinics and testing offer cost-effective solutions that combine health checks and education,” James suggested. “In the UK we recently piloted an innovative programme, called ‘Man Van’, which provided free health checks, including PSA tests, to high-risk men in London aged over 45,” James noted.
“By bringing a van with quick and easy tests directly into the workplace and community, and targeting those at higher risk of prostate cancer, we have provided thousands of health checks resulting in nearly one hundred cancer diagnoses in men who would otherwise only be able to see a doctor once their cancer had progressed to a more advanced stage,” James said.
“The mix of education, awareness, testing and referral used in the ‘Man Van’ study can also be successful in low-income countries and we hope to see similar initiatives spread globally to improve early detection of prostate cancer,” concluded James.
