The year 2022 may prove to have troubling signs ahead for prostate cancer, a disease I've treated thousands of men for in my career. This concerning news comes from the 2022 Cancer Facts & Figures, a report released annually by the American Cancer Society (ACS). Each year, the ACS's report provides an estimate of the number of new cancer cases and deaths in the United States based on recent data on population-based cancer occurrence and outcomes.
Good news first
First, let's start with the good news. The ACS report found that as long as prostate cancer is confined at the time of diagnosis and has not spread or metastasized, men can expect close to a 100% five-year survival rate. This is great news for all men.
Thanks to early detection along with improved treatments and new medications, each has significantly boosted men's rate of survivability of this disease. Given the fact that prostate cancer is the second most common cancer diagnosed in men and the second leading cause of cancer deaths in American men, this is an extraordinary feat for a cancer that can be quite aggressive if not discovered early.
Troubling trends ahead
Now, let's talk about the more concerning news. Unsurprisingly, this report also revealed that the death rate from prostate cancer is no longer declining as quickly. The reason? More men are being diagnosed when their prostate cancer has progressed to an advanced, less treatable stage.
Why is this happening?
Unfortunately, back in 2018, the United States Preventive Services Task Force (USPSTF) decided that screening for prostate cancer, called prostate specific antigen or PSA, offered only a small potential benefit of reducing the chance of death. The task force also had concerns of potential harms PSA screening posed such as false positive results or psychological harms.
This ill-fated decision is turning into a huge blunder. Based on these concerns, the USPSTF recommended that screening for prostate cancer in men aged 55 to 69 should be individualized along with their clinician based on the potential benefits but also harms of PSA screening.
Even the American Cancer Society recommends that the conversation between men and their doctors of when to discuss prostate cancer screenings should begin at age 50 for men at average risk for the disease or age 45 for men with a higher risk for developing prostate cancer. These numbers are too high and could prove to be too late for men, especially with aggressive prostate cancer that's been growing undetected for years. By the time it's found, it could be too late.
This news is extremely disappointing to me when it could have been completely avoided. I've been a strong and vocal advocate for early prostate cancer screenings starting with a prostate specific test or PSA beginning at age 40. That's because young men can and do get diagnosed with prostate cancer.
Prostate cancer found in younger men tends to be more aggressive with a worse prognosis. By having a baseline PSA test at age 40 and each year after that, I as a urologist, can look at the trend of this test looking for any concerning rise over time that might indicate the development of prostate cancer.
Now, because of the foolish 2018 recommendation from the USPSTF, we are now seeing the results of men who decided to forgo a life-saving PSA test for prostate cancer.
Another disturbing finding from the 2022 ACS report is the continued disparities in prostate cancer incidence and death between non-Hispanic Black and white men which remain unacceptably high. Black men have a 75% greater risk of being diagnosed with prostate cancer and are twice as likely to die from a 'low risk' disease.
There is much work to be done in education and ramping up access to PSA screening for this population.
Where do we go from here?
We know that early detection is the key to a successful outcome for every man. There is no denying that survival from prostate cancer or any cancer is significantly improved when caught early.
Part of the problem also points back to the pandemic. Since 2020 at the beginning of COVID-19, I've been worried about the sharp decline in routine screenings for prostate cancer.
When clinics temporarily closed and cancer screenings were put on hold during that time, this is what happens. It does not surprise me that we are now seeing increased numbers of men being diagnosed at more advanced and less treatable stages.
Why am I so passionate about early detection for prostate cancer to reduce it being found at a more advanced stage? I'll put it into perspective: During 2014-2018, the rate of diagnosis of advanced cancers increased by 4% to 6% each year. For those men, the 5-year survival rate was only 31%. Early detection could have helped avoid this scenario.
I want all men to become educated and aware that prostate cancer can be deadly and far too many men will succumb to this disease. The ACS estimates that for 2022, close to 270,000 men will be diagnosed with prostate cancer and 34,500 men will die from it.
This is why it is imperative for men not to put off important cancer screening tests like those used for prostate cancer. Prostate cancer can be a silent killer as symptoms of the disease are often nonexistent.
Certain symptoms might indicate prostate cancer, such as burning or pain during urination, difficulty urinating, reduced flow of a urine stream or blood in urine. But the only way to know for sure is to be screened with a PSA test.
Remember, cancer doesn't wait and neither should men. Get screened for prostate cancer at an early age as it literally can save your life.
Dr. David Samadi is one of America's leading prostate surgeons, a New York City based board-certified Urologic Oncologist Expert and Robotic Surgeon, and the Director of Men's Health and Urologic Oncology at St. Francis Hospital in Long Island. Dr. Samadi is also the author of the men's health and wellness book, "The Ultimate MANual." Read Dr. David Samadi's Reports – More Here.
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