Prostate cancer should not be a death sentence. But for a surprising number of American males, it is

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Rates of America’s second deadliest cancer among men are rising—and they’ve been increasing exponentially for nearly a decade straight.

Since 2014, US diagnoses of prostate cancer — which is highly survivable if caught early — has risen 3% annually. Diagnoses in advanced stages were up 5% year over year.

To make matters worse, black men are diagnosed with the later stages of the condition two to three times as often as white men and are 2.5 times more likely to die from it, experts say.

It’s a fact that experts like American Cancer Society CEO Karen Knudsen are “sounding alarm bells across the country.”

The deaths and disparities are tragic enough. What’s even more tragic: Tens of thousands of American men die each year from a condition that, when caught early, has an almost 100% survival rate. One of the main drivers, according to experts: confusion surrounding screening guidelines issued by the medical staff in 2012 — despite the fact that the controversial recommendations were revised several years later.

As Knudsen points out, “The second leading cause of cancer death in men is survivable cancer.”

The US prostate cancer statistic “tells us something,” she says: “We didn’t find it early enough.”

reason for the rise

In the early 1990s, the US Food and Drug Administration approved a test called PSA — or prostate-specific antigen — for the early detection of prostate cancer. A simple blood draw reveals a protein produced by cells in the prostate gland, with an elevation often indicating prostate cancer. After approval, prostate cancer diagnosis rates began to rise rapidly.

However, elevated PSA levels are not solely caused by prostate cancer. Benign factors such as infection, stimulation from bike riding or vigorous sexual activity can also cause a rise, according to Dr. Bilal Siddiqui, oncologist at the University of Texas MD Anderson Cancer Center.

Inevitably, artificially elevated PSA levels have led to unnecessary biopsies—and with unwanted side effects like enuresis, anxiety, and erectile dysfunction for some. Concerned that the blood test was doing more harm than good, in 2012 the US Preventive Services Task Force changed its guidelines to recommend that it not be used for prostate cancer screening.

Two years later, prostate cancer diagnosis rates began to climb steadily.

“Sometimes when you throw the baby in with the bathwater, you have unintended consequences,” Dr. William Oh — oncologist and professor at the Icahn School of Medicine at Mount Sinai in New York, and chief medical officer for the Prostate Cancer Foundation — tells. luck.

The 2012 recommendation — or reversed recommendation of some kind — “created confusion in the minds of men, but also of primary care providers,” says Knudsen. While the task force updated its recommendation back in 2018 — to make it clear that men ages 55 to 69 should discuss screening with their doctor, weighing the risks and benefits — the damage appears to have been done.

More than a decade after the initial recommendation, Knudsen says, advances in imaging have reduced unnecessary biopsies. Prostate cancer screening is also safe and easy, with “no inherent harm”.

Any longer, there is no reason no To start a conversation about it with a doctor, she adds — especially for men 50 and older, and those with a family history of prostate cancer or a known genetic risk.

“No one should wait to get a prostate exam until they have symptoms,” she says. “It’s simple and a platform to have an important discussion with a doctor.”

Watchful waiting is an option for many patients

Experts say that not all prostate cancers are the same – and that’s good news for the large number of men with the condition. Many prostate cancer patients have “relatively low-grade disease” that has not spread outside the prostate itself, Knudsen says, and treatment may simply involve “watchful waiting.”

Statistics show that men who develop prostate cancer early are less likely to die from it. In fact, studies have found that up to 50% of men who have been autopsied died with Prostate cancer, but not from the condition, Siddiqui says — suggesting that “to some extent,” some of the cellular changes along the spectrum of prostate cancer “may indeed be a normal part of the aging process.”

“There are prostate cancers that will never be fatal in a man’s life,” Oh advises. “As you get older, some men — many men — will develop small amounts of prostate cancer in their prostate. The point of these men is not to treat them if they don’t need treatment. It’s very important to separate these men and do active surveillance.”

These patients contrast with men with a family history of the disease and/or those with genetic risk factors, who often present with more aggressive disease. While it’s famously fueled by breast and ovarian cancer thanks to the advocacy of movie star Angelina Jolie, harmful mutations in the BRCA1 and BRCA2 genes can increase the risk of prostate cancer, experts say. Those with such mutations in BRCA1 have an estimated 30% increased risk of developing prostate cancer during their lifetime, according to a 2022 article in Journal of the National Cancer Institute. This risk rises to 60% among carriers of BRCA2 mutations.

Treatment options for high-risk patients include preparation for radiation therapy and surgery — and these patients should be treated “as aggressively as possible,” Oh says.

People tend to think of prostate cancer as a single condition, which is simply not true, Oh asserts. As Knudsen says, cancer as a whole is more than 200 different diseases, and even cases of prostate cancer can be broken down into groups, or categorized on a spectrum.

A young patient with “aggressive-looking” prostate cancer, whose father had it and carried a BRCA2 mutation, is a very different patient from “an 80-year-old man who happened to undergo a biopsy and showed very low-grade, slow-growing ‘prostate cancer’,” Oh advises.

“These two men could not be more different,” he adds, and their treatment must have been very different, too.

What to look for and when to act

Symptoms of prostate cancer can vary greatly, and some patients don’t show symptoms at all, according to the US Centers for Disease Control and Prevention. However, the following symptoms may be telltale signs:

  • Difficulty starting to urinate
  • Weak or interrupted urine flow
  • frequent urination
  • Trouble emptying the bladder completely
  • Pain or burning while urinating
  • Blood or semen in the urine
  • Back, hip and/or pelvic pain that does not go away
  • Painful ejaculation

Patients diagnosed in the early stages of the condition can have a “high expectation of recovery,” Knudsen says, and “can go on to enjoy an impressive quality of life.” My friend says the five-year survival rate for prostate cancer caught early is nearly 100 percent.

However, the outlook for patients diagnosed late is not rosy. There is no “permanent cure” for such cancer, Knudsen notes. According to my friend, the five-year survival rate for advanced prostate cancer is only 31%.

When it comes to preventing prostate cancer, “what’s good for your heart is good for your prostate,” advises Oh. It encourages men to pack their diets full of leafy greens and colorful fruits, and to limit dairy products and deli meats, which are linked to an increased risk of prostate cancer and prostate cancer.

“Exercise is also associated with a positive outcome,” he adds.

And when it comes to detection? Once men reach their 40s — or earlier if they’re black, have a family history of cancer, or carry a genetic mutation linked to prostate cancer — Oh recommends talking to their primary care provider or urologist about screening. The conversation should happen every year or two.

“Doctors are very busy and have different feelings about everything, especially in the area of ​​cancer screening,” he says. “Unfortunately, cancer screening is more controversial than it should be. Guidelines change often, and they differ from organization to organization. It makes it difficult for the average person to know what to do.”

If you don’t feel heard when talking to your doctor, get a second opinion, he recommends.

Oh adds, “Early detection of a bad disease is always best.”

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