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More men diagnosed with advanced prostate cancer as PSA screening declines

After two decades of decline, cases of prostate cancer rose by 3% per year from 2014 to 2019, a new report from the American Cancer Society has found.

More men are being diagnosed with advanced prostate cancer that is less likely to respond to treatments, a new study from the American Cancer Society suggests.

Prostate cancer, which is the second leading cause of cancer death in men in the U.S., rose by 3% yearly from 2014 to 2019 after two decades of decline, with the increase mostly driven by diagnoses of advanced disease, researchers reported Thursday in CA: A Cancer Journal for Clinicians.

The increases are “worrisome,” said the study’s lead author, Rebecca Siegel, senior scientific director of surveillance research at the American Cancer Society. That’s because prostate cancer that has spread to distant sites beyond the organ is “extremely difficult to treat,” Siegel said. “There is no durable cure for those with metastatic disease,” she added.

The rise in cases of deadly prostate cancer may be partly linked to recommendations against prostate-specific antigen, or PSA, screening for healthy men, experts suggest.

In the new report, Siegel and her colleagues found that the diagnosis of advanced stage prostate cancer increased by 4% to 5% annually since 2011.

“In 2019, 8% were diagnosed at a distant stage, as compared to 4% in 2011, and 14% were diagnosed at a regional stage, versus 11% in 2011, for a total of 22% advanced stage,” Siegel told NBC News.

Once prostate cancer has spread far from the original tumor, the prognosis is grim. The five-year survival rate for these cancers is 32%, according to Siegel.

Even more concerning than the rise in advanced cancer diagnoses is the increased number of prostate cancer deaths.

In 2017, an estimated 26,730 men died from prostate cancer, while in 2022, that number rose to approximately 34,500, said Dr. Ash Tewari, chair of urology at the Icahn School of Medicine at Mount Sinai in New York.

“This increase is concerning and requires a new look at prostate cancer screening,” Tewari said. “On a yearly basis, 8,000 more men died. Essentially, that’s like 16 Boeing 747s crashing.”

Black men had a 70% higher incidence of prostate cancer than white men. Death rates from prostate cancer were two to four times higher in Black men than men in every other racial and ethnic group, the researchers found.

Declines in prostate cancer screening

In 1994, the Food and Drug Administration approved the use of measurements of the prostate specific antigen (PSA) to be used as part of a screening test for prostate cancer. That changed a decade later.

In 2008, the influential U.S. Preventive Services Task Force recommended against PSA screening for men ages 75 and older. The concern was that doctors were diagnosing and treating too many men whose prostate cancer might progress so slowly that the men would die of something else before it became a problem. Treatments could lead to potential side effects such as incontinence and sexual dysfunction.

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