Prostate cancer cases expected to double worldwide
Annual prostate cancer cases are projected to rise from 1.4 million in 2020 to 2.9 million in 2040, and annual deaths to increase by 85% to almost 700,000 over the same timeframe, mainly among men in low-and middle-income countries (LMICs).
Cases of prostate cancer are projected to double from 1.4 million per year in 2020 to 2.9 million per year by 2040, with low- and middle-income countries (LMICs) predicted to see the highest increases in cases, according to The Lancet Commission on prostate cancer which will be launched by a presentation at the European Association of Urology Congress.
The number of annual prostate cancer deaths worldwide is predicted to rise by 85% over the 20-year period, from 375,000 deaths in 2020 to almost 700,000 deaths by 2040. The true numbers will likely be much higher than the recorded figures due to under-diagnosis and missed opportunities for data collection in LMICs.
Most of these deaths are expected to be in LMICs, due to the rising number of cases and increasing mortality rates in these countries. Deaths from prostate cancer have declined in most high-income countries (HICs) since the mid-1990s.
Prostate cancer is already a major cause of death and disability, accounting for 15% of all male cancers. It is the second most common cause of cancer deaths in UK men and the most common form of male cancer in more than half of the world’s countries.
Ageing populations and increasing life expectancy will lead to higher numbers of older men in coming years. As the main risk factors for prostate cancer – such as being aged 50 or older and having a family history of the disease – are unavoidable, it will not be possible to prevent the upcoming surge in cases through lifestyle changes or public health interventions.
Professor Nick James, lead author of the Commission, Professor of Prostate and Bladder Cancer Research at The Institute of Cancer Research, London, and Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust, said: “As more and more men around the world live to middle and old age, there will be an inevitable rise in the number of prostate cancer cases. We know this surge in cases is coming, so we need to start planning and take action now. Evidence-based interventions, such as improved early detection and education programmes, will help to save lives and prevent ill health from prostate cancer in the years to come. This is especially true for low- and middle-income countries which will bear the overwhelming brunt of future cases.”
Global need for new and improved early detection programmes
In HICs, screening for prostate cancer often involves the PSA test, a blood test that measures levels of a protein called prostate-specific antigen (PSA). However, PSA tests often detect prostate cancer which may never cause symptoms and needs no treatment. The current approach to prostate cancer diagnosis in the UK and many other HICs relies on ‘informed choice’ PSA testing – when men aged 50 or over with no disease symptoms can request a PSA test from their doctor after a discussion of the risks and benefits. The Commission argues there is evidence to suggest this approach leads to over-testing in low-risk older men but does not increase detection of prostate cancer in younger men at higher risk. The authors also highlight huge variations in the likelihood of men being diagnosed with advanced prostate cancer with the 'informed choice’ PSA testing strategy, for example The National Prostate Cancer Audit in the UK found that in 2022, 1 in 8 men (12.5%) with prostate cancer are diagnosed with advanced prostate cancer in London, whereas in Scotland more than 1 in 3 (35%) were diagnosed late.
Instead, the authors recommend using MRI scans in combination with PSA testing to screen men at high risk of prostate cancer in HICs, such as those with a family history of the disease, those of African origin and those carrying the BRACA2 mutation. They argue that this approach would both reduce over-diagnosis and over-treatment, while detecting potentially lethal disease. MRI is effective in imaging cancers and can be used to provide information as to whether the disease is aggressive and likely to be life-threatening. However, biopsies are more effective at identifying aggressive cancers, so MRI alone should not be used to investigate men at high risk of disease.
The effectiveness of population-level PSA testing has not been tested in LMICs and there is an urgent need for cancer screening trials in these countries. New approaches to enable earlier diagnosis in LMICs are vital, as most men in these countries present with metastatic cancer – an advanced form of disease where the cancer has spread to other parts of the body, often the bones. Men with late-stage prostate cancer are much less likely to survive for a long period of time than those who are diagnosed early.
“With prostate cancer we cannot wait for people to feel ill and seek help – we must encourage testing in those who feel well but who have a high risk of the disease in order to catch lethal prostate cancer early. Pop-up clinics and mobile testing offer cost-effective solutions that combine health checks and education.
As well as being a major growing challenge, prostate cancer is also an indicator of a wider need to tailor future healthcare to cope with increases in several diseases, as the numbers of men reaching middle and old age increase worldwide. The Commission calls for trials of prostate cancer screening in LMICs to form part of holistic approaches with a broader focus on men’s health. - Source: zerocancer.org
Did you know?
More research involving men of different ethnicities are needed, as current knowledge of prostate cancer is largely based on studies of white men.
Cases of prostate cancer are projected to double from 1.4 million per year in 2020 to 2.9 million per year by 2040, with low- and middle-income countries (LMICs) predicted to see the highest increases in cases, according to The Lancet Commission on prostate cancer which will be launched by a presentation at the European Association of Urology Congress.
The number of annual prostate cancer deaths worldwide is predicted to rise by 85% over the 20-year period, from 375,000 deaths in 2020 to almost 700,000 deaths by 2040. The true numbers will likely be much higher than the recorded figures due to under-diagnosis and missed opportunities for data collection in LMICs.
Most of these deaths are expected to be in LMICs, due to the rising number of cases and increasing mortality rates in these countries. Deaths from prostate cancer have declined in most high-income countries (HICs) since the mid-1990s.
Prostate cancer is already a major cause of death and disability, accounting for 15% of all male cancers. It is the second most common cause of cancer deaths in UK men and the most common form of male cancer in more than half of the world’s countries.
Ageing populations and increasing life expectancy will lead to higher numbers of older men in coming years. As the main risk factors for prostate cancer – such as being aged 50 or older and having a family history of the disease – are unavoidable, it will not be possible to prevent the upcoming surge in cases through lifestyle changes or public health interventions.
Professor Nick James, lead author of the Commission, Professor of Prostate and Bladder Cancer Research at The Institute of Cancer Research, London, and Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust, said: “As more and more men around the world live to middle and old age, there will be an inevitable rise in the number of prostate cancer cases. We know this surge in cases is coming, so we need to start planning and take action now. Evidence-based interventions, such as improved early detection and education programmes, will help to save lives and prevent ill health from prostate cancer in the years to come. This is especially true for low- and middle-income countries which will bear the overwhelming brunt of future cases.”
Global need for new and improved early detection programmes
In HICs, screening for prostate cancer often involves the PSA test, a blood test that measures levels of a protein called prostate-specific antigen (PSA). However, PSA tests often detect prostate cancer which may never cause symptoms and needs no treatment. The current approach to prostate cancer diagnosis in the UK and many other HICs relies on ‘informed choice’ PSA testing – when men aged 50 or over with no disease symptoms can request a PSA test from their doctor after a discussion of the risks and benefits. The Commission argues there is evidence to suggest this approach leads to over-testing in low-risk older men but does not increase detection of prostate cancer in younger men at higher risk. The authors also highlight huge variations in the likelihood of men being diagnosed with advanced prostate cancer with the 'informed choice’ PSA testing strategy, for example The National Prostate Cancer Audit in the UK found that in 2022, 1 in 8 men (12.5%) with prostate cancer are diagnosed with advanced prostate cancer in London, whereas in Scotland more than 1 in 3 (35%) were diagnosed late.
Instead, the authors recommend using MRI scans in combination with PSA testing to screen men at high risk of prostate cancer in HICs, such as those with a family history of the disease, those of African origin and those carrying the BRACA2 mutation. They argue that this approach would both reduce over-diagnosis and over-treatment, while detecting potentially lethal disease. MRI is effective in imaging cancers and can be used to provide information as to whether the disease is aggressive and likely to be life-threatening. However, biopsies are more effective at identifying aggressive cancers, so MRI alone should not be used to investigate men at high risk of disease.
The effectiveness of population-level PSA testing has not been tested in LMICs and there is an urgent need for cancer screening trials in these countries. New approaches to enable earlier diagnosis in LMICs are vital, as most men in these countries present with metastatic cancer – an advanced form of disease where the cancer has spread to other parts of the body, often the bones. Men with late-stage prostate cancer are much less likely to survive for a long period of time than those who are diagnosed early.
“With prostate cancer we cannot wait for people to feel ill and seek help – we must encourage testing in those who feel well but who have a high risk of the disease in order to catch lethal prostate cancer early. Pop-up clinics and mobile testing offer cost-effective solutions that combine health checks and education.
As well as being a major growing challenge, prostate cancer is also an indicator of a wider need to tailor future healthcare to cope with increases in several diseases, as the numbers of men reaching middle and old age increase worldwide. The Commission calls for trials of prostate cancer screening in LMICs to form part of holistic approaches with a broader focus on men’s health. - Source: zerocancer.org
Did you know?
More research involving men of different ethnicities are needed, as current knowledge of prostate cancer is largely based on studies of white men.
