Prostate-specific antigen (PSA) testing can identify early prostate cancer, and when diagnosed at an early stage, prostate cancer is almost always curable.
But the incidence of prostate cancer increased by 3% annually from 2014 through 2019 after two decades of decline. The increased incidence rate comes on the heels of steep declines in previous years. As a result, more men are being diagnosed with advanced prostate cancer that is less likely to respond to treatment.
Overdiagnosis and Overtreatment
The new data suggest that the increased incidence of prostate cancer is driven by diagnosis of advanced disease. Prostate cancer that has spread beyond the prostate is more difficult to treat. The rise in advanced cancer diagnoses has also led to an increased number of prostate cancer deaths.
This is particularly concerning for Black men. In the most recent data from the American Cancer Society, 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.
Many prostate cancers are slow growing and may never result in harm or shorten life. Once a prostate cancer has been diagnosed, there exists the risk for overdiagnosis and overtreatment -- that is, you receive treatment you don't necessarily need.
Smarter PSA Screening
In the past, when a patient was diagnosed with prostate cancer, the doctor might have recommended immediate treatment. Now active surveillance is recommended, because prostate cancer treatment is rife with side effects.
Not every prostate cancer detected with PSA testing needs intervention, and not every prostate cancer needs a biopsy. Most academic institutions use advanced PSA screening, considering the patient's age and life expectancy and depending on how fast the prostate cancer is growing, and do sequential PSA testing.
Recent advances in more targeted screening make use of molecular markers and imaging techniques to target prostate cancer biopsies. And it's important to find cancers early on. When diagnosed early, prostate cancer is curable in 99% of patients, but once it has spread far from the original tumor, the 5-year survival rate is only 32%.
Shared Decision-Making
Make sure to discuss with your doctor your risks for prostate cancer and what the most appropriate screening is for your situation. Once prostate cancer is diagnosed, ask your doctor whether you are a candidate for active surveillance.
Discuss the pros and cons of PSA testing with your doctor and make a decision together about the next steps. New treatments can lead to fewer side effects and allow you to live a long, healthy life.
Read previous installments in this series:
For Your Patients: Risk Factors, Signs, and Symptoms of Prostate Cancer
For Your Patients: How Will My Doctor Diagnose Prostate Cancer?
Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.
