Here’s the state of prostate cancer, according to a new Lancet Commission on Prostate Cancer report just published on April 4 in The Lancet. It’s already the most common cancer among men in 112 different countries, comprising around 15% of all male cancers around the world. And it’s going to keep getting a whole lot more “commoner.” The report estimated that the number of new prostate cancer cases is going to go from 1.4 million in 2020 to 2.9 million by 2040. That would amount to an over two-fold increase in just two decades.
If you wanted to put a finger on this prostate situation and what’s causing this surge, you could point to several factors. Prostate cancer rates had already been on an upward trend prior to 2020, so part of this forecasted growth is an extrapolation of what’s been happening. Plus, as the population continues to grow, you got males—more and more males in the future. Moreover, with life expectancy getting longer, more and more males will be living well (or unwell) into the age ranges where prostate cancer becomes more and more likely.
The Commission warned that much more needs to be done to address this continuing surge and that “Without urgent action, these trends will cause global deaths from prostate cancer to rise rapidly.” In 2020, prostate cancer was responsible for about 375,000 deaths around the world, a number that could mushroom as well unless things change. Although prostate cancer can be treatable if caught early enough, survival is less likely with either more aggressive cases or those that are diagnosed at later stages.
That’s why prostate cancer surveillance is so important. You can’t see your prostate in the mirror or selfies unless something has gone horribly wrong. And prostate cancer doesn’t tend to cause symptoms until it’s more advanced. Therefore, you have to rely on regularly checking prostate specific antigen (PSA) levels in your blood when you are 50 years or older—earlier if you are higher risk such as a family history of people having prostate cancer at earlier ages. Not everyone is doing such checks. In fact, many people is lower income settings may not even have access to such testing. Far too many people around the world are still getting diagnosed way too late in the course of their disease.
Therefore, the Lancet Commission emphasized the need to make sure that everyone in high, middle and low income countries is getting tested when appropriate. It’s not enough to make testing available either. There needs to be enough communication to all of the public and resulting awareness about the importance of prostate cancer screening and the consequences of the disease.
Another issue is that the PSA is not perfect. Elevated levels don’t always mean prostate cancer. Normal levels do not necessarily rule out prostate cancer. Shawn Dason, MD, an Assistant Professor of Urology at The Ohio State University College of Medicine, called the PSA “a broadly useful number. There is elevated risk of prostate caner associated with elevated values.” While a biopsy ultimately may be needed to determine whether someone has prostate cancer, you can’t just tell everyone who has a prostate to regularly get biopsied since getting such a procedure is probably not on too many people’s list of fun things to do. Plus, an excessive number of prostate biopsies could be quite expensive for society. Therefore, the Lancet Commission called for the development of more testing options such as new types of blood tests and imaging approaches that can increase the accuracy of prostate cancer screening.
Then there’s the treatment of prostate cancer. While more and better treatment options exist these days compared to several decades ago, these options are still far from perfect. Treatments may not be able to get rid of all the cancer. And each of the currently available options have their drawbacks and side effects. For example, Dason described two very common effects of surgical removal of the prostate: “One is urinary incontinence. For most men this will eventually resolve. The other is erectile dysfunction. Over time, men can regain function but it depends on how many of the nerves that affect erections can be preserved during surgery.” Thus, it’s not surprising that the Lancet Commission called for more research into developing and establishing more and even better treatment options.
Finally, much of the research to date has focused on certain specific demographics rather than everyone around the world. Can you guess which demographic groups have gotten most of the attention? Well, one is males, which makes sense since they are typically the ones with prostates. The other is those of European heritage. In other words, many research studies have not included those of other heritages such as African, even though the incidence of prostate cancer in men of African heritage is around twice that of men of European heritage. The Lancet Commission did recommend that this inequity be properly addressed and that prostate cancer research, surveillance and treatment efforts encompass a broader, more diverse range of people.
Fulfilling all of the Lancet Commission’s recommendations will require that little thing called money and other accompanying resources. This is where political and business leaders come into play since they do control many of the resources. The big question is whether such leaders will actually heed the need for urgent action. After all, many such leaders don’t exactly have the best track record of paying enough attention to such calls until it is too late. Instead, they often don’t deal with something until it’s immediately right in front of their faces. And your prostate—if you do have one—is typically not in front of anyone’s face. Instead, it should sit right beneath your bladder and in front of your rectum, surrounding your urethra. But just because something is not seen and heard doesn’t mean that it shouldn’t be taken very seriously.
