Prostate cancer tsunami coming, experts warn

'inevitable' global surge prostate cancer By 2040, the number of global infections will double to 2.9 million, and the death toll will increase by 85% to nearly 700,000. lancet The Prostate Cancer Committee warned this week.

The committee told a meeting of urologists in Paris, France, that the acceleration has already begun in high-income countries such as the United States and the United Kingdom, but will accelerate further in low- and middle-income countries.

Nick James, MD, lead author lancet prostate report and professor, bladder cancer A study from the Institute of Cancer Research in London says this surge is partly a medical success story.

“Paradoxically, prostate cancer is a problem built into biology. Men develop prostate cancer as they age,” James said. Medscape Medical News.

“We're seeing a big increase in high-income countries. But in the coming decades, poor countries will see a big increase in the number of 50, 60 and 70-year-olds. “Prostate cancer will rise even more. Other high-income countries, too, will see a smaller increase for the same reason.

report will be presented at the 2024 European Urological Association Congress to be held in Paris on April 6th.

According to the report, “The need for prostate cancer screening for all men aged 50 to 70 (and men of African descent aged 45 to 70) in high-income countries is being strengthened by improved access to technology such as MRI. Evidence of the safety of active surveillance is growing. ”

“It's important to note that this is a significant increase in cancer risk,” said Dr. Andrew Vickers, a biostatistician at Memorial Sloan Kettering Cancer Center in New York City. lancet The committee reached a similar conclusion to what he and a group of international researchers came to in their investigation. 2023 policy document in BMJ. A big gap, Vickers said, is the misuse of prostate-specific antigen (PSA) screening.

“The universal policy compromise of letting patients decide for themselves about PSA has led to the worst outcomes: overuse in men with poor outcomes, high rates of overdiagnosis and overtreatment, and economic and racial inequalities. “We found out there was,” Vickers said. “Our view is that PSA screening can be done appropriately by introducing direct harm reduction strategies, such as limiting screening of older men and using secondary testing before biopsy, or not at all. It should not be.”

James said undertreatment of advanced disease is widespread. For example, only about 30 to 40 percent of men in the United States receive combination hormone therapy for metastatic disease. “Just doing what we know works will improve outcomes,” he said.

James said men of African descent are twice as likely to develop prostate cancer, but it is unclear whether these men need a different approach to treatment. A new report highlights the need to include more African men in research.

Brandon Mahal, M.D., vice director of radiation oncology research at the University of Miami Sylvester Comprehensive Cancer Center and co-author of the report, said new approaches are needed to enable early diagnosis of low-to-moderate prostate cancer in men. said that it is necessary. In income countries, most patients have metastatic disease and are unlikely to survive long-term.

Mr James recommended pop-up clinics and mobile testing to help men who are at high risk for prostate cancer but feel healthy to catch the deadly cancer early.

In the UK, for example, James helped introduce a support program called “The Man Van'' that provided free health checks, including PSA tests, to high-risk men in London.

“By delivering vans equipped with quick and easy tests directly to men in their workplaces and communities, and targeting those at high risk of prostate cancer, we are delivering thousands of health checks, resulting in prostate cancer. “Almost 100 cancer diagnoses have been made in men who may have cancer, but only seek medical attention when their cancer is at a more advanced stage,” he said. .

He noted that the medical community around the world is ill-prepared for the rapid increase in prostate cancer patients.

“The solution cannot be to train more urologists, radiation oncologists, pathologists and radiologists, because that would simply take too much time,” James says. However, increasing the use of nurses and artificial intelligence may help. “In my own hospital, biopsies are nurse-led. AI is already very good at diagnosis and will continue to get better,” he said.

Smartphones could fill the gap even in poor countries. “The same technology that we use for facial recognition is already able to tell that it's Gleason 7 prostate cancer,” James says. “Of course it has not been rolled out in countries like the United States because pathologists' incomes are at risk.”

James, Vickers, and Mahal report no relevant financial conflicts of interest.

Howard Wolinsky is a medical writer living in Chicago.