Prostate Cancer Update: Advanced Cases Rising

Andrew Siegel MD  1/9/2021

The Center for Disease Control and Prevention (CDC) publishes a weekly Morbidity and Mortality Weekly Report (MMWR). A recent topic was Prostate Cancer Incidence and Survival, by Stage and Race/Ethnicity—United States, 2001-2017.  Today’s entry summarizes the findings of the CDC.

Take home message: The incidence of advanced prostate cancer (spread to parts of the body remote from the prostate) in the USA has been rising over the past decade.

Uptick in prostate cancer mortality following USPSTF (United States Preventive Services Task Force) advice against PSA screening

Summary of CDC Findings:

  • 3.1 million new cases of prostate cancer from 2003-2017
  • Incidence decreased from 155/100,00 in 2003 to 105/100,000 in 2017
  • Incidence of localized prostate cancer decreased from 78% in 2003 to 70% in 2017
  • Incidence of distant prostate cancer increased from 4% in 2003 to 8% in 2017
  • Highest incidence: age 70-74
  • Highest incidence: African-American men
  • 77% localized (confined to prostate), 11% regional (direct extension to adjacent organs or lymph nodes), 5% metastatic (spread to remote parts of body), 7% unknown
  • 10-year survival rate for localized, regional and metastatic disease: 100%, 96% and 19% respectively
  • Prostate cancer second leading cause of cancer-related death in the USA

Why the surge in metastatic prostate cancer?

In 2012, the USPSTF (United States Preventive Services Task Force) issued a grade D recommendation against the use of PSA screening in the general population.

The CDC report concluded: “This USPSTF recommendation likely contributed to a decrease in overall reported prostate cancer incidence and might have contributed to an increase in the percentage and incidence of advanced prostate cancer.”  In my humble opinion as a busy urologist who evaluates and manages prostate cancer on a daily basis, the aforementioned CDC statement was diplomatic “sugar coating” and that the truth of the matter is that the short-sighted USPSTF recommendation in 2012 clearly resulted in a significant reduction in PSA screening and is without doubt the cause of the spike in cases of advanced disease and death, since screening is fundamental for discovering prostate cancer in its earliest and most treatable and curable stages. 

Horse’s Ass Award to USPSTF

Subsequently, in 2018 the USPSTF issued a new recommendation that prostate cancer screening in men age 55-69 should be an individualized decision based on personal preferences, weighing the benefits and harms of screening.  In my opinion, this is still far too non-inclusive and my recommendation is to commence screening at age 40 and continue to an age based upon physiological age as opposed to chronological age.

Bottom Line: Although about three-fourths of men with prostate cancer have localized disease at diagnosis, an increasing number of men are presenting with advanced prostate cancer.  Survival of advanced prostate cancer has certainly improved based upon new medications and treatments, yet fewer than one-third of men with advanced disease survive 5 years following diagnosis. Screening for prostate cancer with digital rectal examination and PSA is of fundamental importance for identifying prostate cancer in its earliest and most curable stages. Prostate cancer causes NO symptoms early on and must be actively sought after and screened for in order to offer patients the best chance for cure.

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.  His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families. 

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours). 

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health


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One Response to “Prostate Cancer Update: Advanced Cases Rising”

  1. Chris O'Neill Says:

    “In 2012, the USPSTF (United States Preventive Services Task Force) issued a grade D recommendation against the use of PSA screening in the general population.”

    Prostate Cancer does not usually cause death until 10 years or more after it would be detected through PSA screening. So blaming an increase in mortality in 2016 on a decrease in screening after 2012 is drawing a long bow.

    In any case, making conclusions from observational correlations is not proof.

    Controlled trials of PSA screening, such as those done within the ERSPC, have mistakenly been lumped lumped together by the ERSPC in order to claim a general prostate cancer specific mortality benefit. The lumping together of different trials was justified by failing to prove the different trials were inconsistent. The ERSPC made the mistake of assuming absence of evidence of inhomogeneity between trials is evidence of absence, thus making the lumping together of different trials and the conclusions therefrom unfounded.

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