Prostate cancer should not be a death sentence. But for a surprising number of American men, it’s

Since 2014, diagnoses of prostate cancer in the US, highly survivable if caught early, have increased 3% annually. Late-stage diagnoses have increased 5% year-over-year.

Adding insult to injury, black men are being diagnosed with late-stage disease at two to three times the rate of white men, and are also about 2.5 times more likely to die from it. say the experts.

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

The deaths and disparities are quite tragic. What’s even more tragic is that tens of thousands of men in the US die every year from a condition that, when caught early, has a nearly 100% survival rate. One big factor, experts say: confusion around screening guidelines issued by a medical task force in 2012, even though the controversial recommendations were revised several years later.

As Knudsen points out, “the second leading cause of cancer death in men is long-lasting cancer.”

US prostate cancer statistics “tell us something,” he says: “We’re not finding it early enough.”

The reason behind the increase

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 detects a protein produced by cells in the prostate gland, and an increase often indicates prostate cancer. After approval, prostate cancer diagnosis rates began to rise rapidly.

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

Inevitably, artificially elevated PSA levels resulted in unnecessary biopsies and, along with them, undesirable side effects such as incontinence, anxiety, and erectile dysfunction in 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 a steady climb.

“Sometimes when you flush the baby out with the bathwater, you have unintended consequences,” said Dr. William Oh, an oncologist and professor at the Icahn School of Medicine at Mount Sinai in New York, and medical director of Prostate Cancer. Foundation. he says Fortune.

The 2012 recommendation, or reverse recommendation, “created confusion in the minds of men, but also in primary care providers,” Knudsen says. While the task force updated its recommendation again in 2018, to say that men between the ages of 55 and 69 should discuss screening with their doctor, weighing the risk and benefits, the damage appeared to have been done.

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

more, there is no reason No to start a conversation about it with your doctor, he adds, especially for men age 50 and older, and those with a family history of prostate cancer or known genetic risk.

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

‘Watchful waiting’ an option for many patients

Not all prostate cancer is the same, experts say, and that’s good news for a large number of men with the condition. Many prostate cancer patients have “relatively low-grade disease” that hasn’t spread beyond the prostate itself, and treatment may simply involve “watchful waiting,” Knudsen says.

Men who get prostate cancer early are unlikely to die from it, statistics show. In fact, studies have found that up to 50% of men who were autopsied died with prostate cancer, but not of the condition, indicating that, “to some extent,” some cellular changes along the spectrum of prostate cancer “may be a normal part of the aging process,” Siddiqui says.

“There are prostate cancers that will never be lethal in a man’s lifetime,” Oh advises. “As he gets older, some men, many men, will have small amounts of prostate cancer in the prostate. The goal with these men is not to treat them if they don’t need treatment. It is very important to separate these men and do active surveillance.”

Such patients are in contrast to men with a family history of the disease and/or those who have genetic risk factors, who often face more aggressive disease. While famous for driving breast and ovarian cancers thanks to the advocacy of movie star Angelina Jolie, harmful mutations in the BRCA1 and BRCA2 genes may also confer an increased risk of prostate cancer, experts say. Those with such BRCA1 mutations have an estimated 30 percent risk of developing prostate cancer during their lifetime, according to a 2022 article in the journal Journal of the National Cancer Institute. That risk increases to 60% among carriers of BRCA2 mutations.

Options for treating high-risk and predisposed patients include radiation and surgery, and such patients should be treated “as aggressively as possible,” Oh says.

People tend to think of prostate cancer as a condition, and that’s just not true, Oh says. As Knudsen says, cancer as a whole is more than 200 different diseases, and even prostate cancer cases can be divided into groups or categorized on a spectrum.

A young patient with “aggressive-looking” prostate cancer, whose father had the condition and who carries a BRCA2 mutation, is a completely different patient from “an 80-year-old man who had a biopsy and it shows very low.” slow-growing prostate cancer,” advises Oh.

“Those two men couldn’t be more different,” and their treatment should also be very different, he adds.

What to look for and when to act

The symptoms of prostate cancer can vary widely, with some patients showing no symptoms at all, according to the US Centers for Disease Control and Prevention. The following symptoms, however, can be telltale signs:

• Difficulty starting to urinate
• Weak urine flow or interrupted flow
• frequent urination
• Problems emptying the bladder completely
• Pain or burning when 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 cure,” Knudsen says, and “can go on to have a wonderful quality of life.” In fact, the five-year survival rate for prostate cancer detected early is nearly 100%, says Siddiqui.

However, the outlook for late-diagnosed patients is not so rosy. There is no “long-lasting cure” for this type of cancer, Knudsen notes. The five-year survival rate for advanced prostate cancer is only 31%, according to Siddiqui.

When it comes to prostate cancer prevention, “what’s good for the heart is good for the prostate,” Oh advises. She encourages men to pack their diets with leafy green vegetables and colorful fruits, and to limit dairy products and grilled meat, which are associated with increased risk of prostate cancer and aggressive prostate cancer.

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

And when it comes to detection? Once men are 40, or earlier if they’re black, have a family history of cancer, or have a genetic mutation associated with prostate cancer, Oh recommends they talk to their primary care provider or urologist about screening. The conversation should happen every one or two years.

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

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

Adds Oh: “Early detection of serious disease is always better.”