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Prostate cancer is the second leading cancer in men. While rates for some types of prostate cancer have declined in the U.S., advanced prostate cancer cases have increased. Scientists are looking into reasons why.

Trends in Prostate Cancer

Research from the CDC and the National Cancer Institute shows a drop in the rate of new prostate cancer cases:

  • 1999: 169 per 100,000 men
  • 2019: 111 per 100,000 men

But despite this good news, the overall number of new prostate cancer cases and deaths is on the rise in the U.S.:

  • 2014: 182,806 new prostate cancer cases
  • 2019: 224,733 new prostate cancer cases

Researchers say the number of new cases has gone up because there are simply more people, and the U.S. population is aging. Older men are more likely to get prostate cancer.
 

Advanced Prostate Cancer on the Rise

Meanwhile, in a separate study, researchers looked at trends in metastatic, or advanced, prostate cancer from 2004 to 2018. This is when cancer has spread from its origin to another part of your body. 

They found that the rate of advanced prostate cancer was stable or dropped for men ages 45 and older from 2004 to around 2010 or 2011. But it has started to rise over the past 10 years or so. Here’s a look at the numbers by age group: 

  • Ages 45-74: up 41% from 2010-2018
  • Ages 75 and older: up 43% from 2011-2018

All races across these age groups have seen more metastatic prostate cancers. Experts say that coincides with a drop-off in prostate cancer screening. 

The History of Screening for Prostate Cancer

Nearly 30 years ago, doctors in the U.S. started routinely screening for prostate cancer using the prostate-specific antigen (PSA) test. It detects the amount of PSA in your blood – a higher level means you could have cancer. PSA screenings led to fewer men living with and dying from prostate cancer, including the metastatic form of the disease.

In 2008, an independent panel of health and medicine experts suggested that men over age 75 stop having routine PSA screenings. In 2012, the panel expanded its guidance to include all men. It found that while prostate cancer screening has many benefits, there are also drawbacks.

Pros and Cons of Prostate Cancer Screening

 

The panel and other experts were concerned about the harm men face from false positive PSA results. This happens when your test shows a higher PSA level, but you don’t actually have prostate cancer. If your result comes back with a false positive, your doctor will likely suggest a prostate biopsy, a test you don’t need when you’re cancer-free. 

In that biopsy, your doctor removes some prostate tissue to test it for cancer cells. Older men face more potential problems after a prostate biopsy, such as:

  • Pain
  • Blood in seminal fluid
  • Infection

One study found that 40% of men had health problems after a prostate biopsy, but they weren’t usually serious.

There’s also worry about overtreatment. Some men have prostate cancer but continue to live symptom-free. But if you have cancer treatment like surgery or radiation, you may risk other health issues, including loss of bladder and bowel control, and trouble getting or keeping an erection.

Lowering Advanced Prostate Cancer Numbers

Research shows that after the independent panel issued its guidance, prostate cancer screenings began to dip for men of all ages and races, while advanced prostate cancer cases started to climb. Scientists say there may be more reasons for that spike, like better tools to diagnose metastatic prostate cancer.

Here are some ways to track your prostate health while avoiding testing and treatment you don’t need:

Active surveillance. More doctors are using a monitoring approach called “active surveillance.” It’s when you defer treatment until there are signs your cancer has worsened. Depending on your situation and health care provider, you’ll have regular PSA tests and biopsies.

Researchers estimate that 60% of U.S. men living with the types of prostate cancer that are less likely to cause death – called low-risk prostate cancer – are under active surveillance. This is double the number over the previous 7 years.

Genetic and molecular testing. Doctors are now using this type of testing to figure out whether to suggest active surveillance. If you have a family member with cancer, or your doctor diagnoses you with “intermediate-risk” prostate cancer, you may be tested for changes to your BRCA2 gene and other genes linked to cancer.

Tailored screening. In 2018, the independent panel that advised men to stop having routine PSA screenings amended its position. Panel members now suggest screening on a case-by-case basis for men ages 55 to 69. They referenced recent scientific studies, which show screening can help men avoid advanced prostate cancer and death from the disease. 
 

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SOURCES:

Photo Credit: LWA/Dann Tardif / Getty Images

JAMA Network Open: “Trends in Incidence of Metastatic Prostate Cancer in the US,” “Striking the Right Balance With Prostate Cancer Screening.”

Keck Medicine of USC: “Metastatic prostate cancer on the rise since decrease in cancer screenings.”

Healio Hematology/Oncology: “Screening strategies could reduce prostate cancer mortality, overdiagnosis among Black men.”

CDC: “United States Cancer Statistics: Data Visualizations,” “What Are the Benefits and Harms of Screening?”

Harvard Health Publishing: “Prostate biopsy side effects are common.”

National Cancer Institute: “Active Surveillance for Low-Risk Prostate Cancer Continues to Rise.”

American Cancer Society: “Key Statistics for Prostate Cancer.”