According to a new study, the cases of prostate cancer have increased by over 72% in the last decade in the United States. It is believed that this massive increase could be linked to fewer number of screenings for early prostate cancer detection. Another factor cited was the possibility that prostate cancer had somehow become more aggressive. The researchers looked at information from the National Cancer Database, which included more than 767,000 men from 1,089 medical facilities nationwide who had been diagnosed with prostate cancer between 2004 and 2013.
The report was published on 19th July, 2016, in the Prostate Cancer and Prostatic Diseases, a journal run by Nature. “One hypothesis is the disease has become more aggressive, regardless of the change in screening,” senior study author Dr Edward Schaeffer, chair of urology at Northwestern University Feinberg School of Medicine and Northwestern Medicine, said in a statement. “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.”
The researchers focused on metastatic cases, meaning cases where the cancer had spread from the prostate to other parts of the body by the time it was diagnosed. Just 3% of the patients had metastatic prostate cancer. The researchers found that the largest increase was seen among men 55 to 69 years old. That age group saw a 92% increase in cases in the last decade, from 702 new cases in 2004 to 1,345 in 2013. This massive increase is quite alarming, according to the authors, because men in this age group are believed to benefit most from prostate cancer screening with the PSA, which stands for prostate-specific antigen blood test, and early treatment. The rate of metastatic prostate cancer overall increased 72 percent, from 1,685 cases in 2004 to 2,890 in 2013.
The report also found that the average PSA level of men diagnosed with metastatic prostate cancer in 2013 was 49 which was approximately double that of men who were diagnosed in 2004, who had an average PSA of 25. This is a valid indicator of a significant spread of disease at diagnosis, as the blood level of PSA, which is a protein produced by the prostate gland, is mostly increased in men diagnosed with prostate cancer.
Fewer Men Are Having PSA Tests
The authors note that fewer men are now being screened for prostate cancer following a 2012 recommendation by the US Preventive Services Task Force against routine PSA tests to detect prostate cancer. The group cited sufficient proof that “PSA-based screening results in significant over-diagnosis” and many false positives that cause a lot of misdiagnosis and unnecessary health expenses.
However, not everyone in the health community conforms with these guidelines. Schaffer said that men in 2013 had more PSAs than men in 2004 which meant that the disease was getting more aggressive and patients had to be more vigilant.
Dr Eric Klein, chairman of the Glickman Urological & Kidney Institute at Cleveland Clinic, said he believes the USPTF’s advise against PSA screenings played a key part in the massive increase in metastatic prostate cancer cases observed in the study.
Dr Klein also found the USPTF’s recommendation nonproductive, citing the need for more accurate blood and urine tests and the popular trend of delaying early treatment in favor of analytical proceeding as symptoms become more prominent.
But the American Cancer Society has criticized the PSA screening used in the latest study, saying a more accurate measure would be to study the rates of disease and mortality, as compared to simply counting the number of cases of prostate cancer.
“Epidemiologists learned long ago that you can’t simply look at raw numbers. A rising number of cases can be due simply to a growing and aging population among other factors,” the American Cancer Society’s chief medical officer Dr Otis W Brawley said in a statement. “In addition, in this study, the rise they detected began before USPSTF guidelines for screening changed. There may or may not be a rise in the rates of metastatic disease, but because of a flawed analysis, this study does not answer that important question.
Who Should Get PSA Screenings?
Prostate cancer is the most common cancer found in American men, and the second leading cause of men’s cancer deaths.
Given those rates, it would seem like a screening test that can catch the disease early would be a major boon to medical care. However, it’s much more complicated than that. The PSA test is a blood test that looks for a specific protein that is only produced by the prostate. The higher the levels of PSA, the more likely the person has prostate cancer.
If someone is found to have an elevated level of the PSA protein in their blood, they are usually advised to have a biopsy extracted from their prostate. This process involves inserting 12 needles into the prostate using an ultrasound test and taking a random sample of their prostate tissue.
The issue is that the many number of tumors are not significant enough to proceed treatment. One study suggested that 40 percent of men who receive a positive test result have a cancer too malignant to be considered fatal. The biopsies, radiation, surgery and other treatments can cause adverse side effects, including impotence, incontinence and other complications, and could even lead to death in some cases.
That was the reason why the US Preventative Services Task Force recommended against healthy, symptom-free men of any age getting the PSA test in May 2012 guidelines. Before that, men over the age of 75 were advised not to get the test.
Many experts do believe that PSA screenings play a significant role in diagnosing prostate cancer, since the only other method left would be a digital rectal exam, when a doctor checks the prostate through the rectum using his or her fingers. Some tumors can be felt, but not others, and they are often discovered too late.
Safeguarding Prostate Health
Studies show that a diet rich in omega-3 fatty acids helps slow the growth of prostate cancer cells, which could be crucial as it is easier to treat prostate cancer if its spread has been contained. Omega-3 fatty acids are abundantly found in fish and other sources including nuts and certain plant seeds.
Coming round to the potential benefits of green tea, not only does drinking green tea speed up metabolism and help burn off fats more quickly, it contains catechins that prevent cancer cell growth. A study found that men who drank as little as 500 milligrams of a green and black tea blend with their food showed improved urine flow, decreased inflammation, and overall improved prostate health in as little as six weeks. Combine this diet with exercise, eating vegetables and reducing the number of cigarettes smoked can improve overall health as well.