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Published on September 07, 2016

Prostate cancer is more common than breast cancerProstate cancer is more common than breast cancer

September is Prostate Cancer Awareness month, and there are some worrisome changes occurring with prostate cancer.

During July, several consumer magazines caught the buzz from a July 19 publication in Prostate Cancer and Prostatic Diseases– a journal of Nature. There has been a near doubling of metastatic prostate cancers among 55-64-year-olds from 2004 to 2013.This was abstracted in the July 20, 2016 CoC ‘The Brief.”

The number of new cases of metastatic prostate cancer climbed 72 percent in the past decade from 2004 to 2013, reports a new Northwestern Medicine study. The report considers whether a recent trend of fewer men being screened may be contributing to the rise, or whether the disease has become more aggressive—or both.

The largest increase in new cases was among men 55 to 69 years old, which rose 92 percent in the past decade. This rise is particularly troubling, the authors said, because men in this age group are believed to benefit most from prostate cancer screening and early treatment.

In addition, the average PSA (prostate-specific antigen) of men who were diagnosed with metastatic prostate cancer in 2013 was 49, nearly double that for men diagnosed in 2004 with an average PSA of 25, indicating a greater extent of disease at diagnosis.

The blood level of PSA, a protein produced by cells of the prostate gland, is often elevated in men with prostate cancer.

The Disease Is More Aggressive

“One hypothesis is the disease has become more aggressive, regardless of the change in screening,” said senior study author Dr. Edward Schaeffer, chair of urology at Northwestern University Feinberg School of Medicine and Northwestern Medicine. “The other idea is since screening guidelines have become more lax, when men do get diagnosed, it’s at a more advanced stage of disease. Probably both are true. We don’t know for sure but this is the focus of our current work.”

Dr. Schaeffer also is a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. His research team analyzed information from the National Cancer Data Base. It included 767,550 men from 1,089 facilities nationwide who had been diagnosed with prostate cancer between 2004 and 2013.

Over the past decade, there has been a substantial reduction in the number of men being screened for prostate cancer and an associated decline in the overall number of new cases of prostate cancer being reported.

“The fact that men in 2013 who presented with metastatic disease had much higher PSAs than similar men in 2004 hints that more aggressive disease is on the rise,” Dr. Schaeffer said. “If I were a patient, I would want to be vigilant. I firmly believe that PSA screening and rectal exams save lives.”

In Massachusetts, incidence and mortality rates from prostate cancer mortality are greater than breast cancer. May I rephrase this? Prostate cancer kills more men than breast cancer kills women! Who would have known this? Gail Merriam and the Mass DPH reported this in the latest Massachusetts Comprehensive Cancer Control and Prevention Program report.massachusetts cancers

Let’s take a quick look at Massachusetts Prostate Cancer by CDC county data then the NCDB concerning stage at diagnosis, age at diagnosis and what hashappened in Massachusetts from 2003-2013.incidence rates

Here are Prostate Cancer 2009 and 2010 screening recommendations from the AUA and America Cancer Society respectively:

screening

As you can see from the data presented, we need to decrease deaths from prostate cancer. PCP’s need to rethink screening recommendations and identify prostate cancer earlier- before it is incurable. Multidisciplinary teams then need to sort out which prostate cancers are life threatening and treat them accordingly.