Is Aggressive Prostate Cancer on the Rise? Experts Disagree

In a recently published article in the journal Prostate Cancer and Prostatic Diseases, researchers report that the incidence of aggressive prostate cancer in newly diagnosed elderly men has nearly doubled since 2004. In that same time the total number of prostate cancer diagnoses has remained relatively stable. And the total number of men diagnosed with metastatic prostate cancer has also remained the same--3% of all first time diagnoses.  

Metastatic refers to cancer that starts in one location, such as the prostate, and then spreads to other parts of the body, such as the bladder, lymph nodes, bones, and lungs.

What has caused this increase? Honestly, nobody knows. Researchers have hypothesized (guessed) that there could be two (or more) reasons:

1 The U.S. Preventive Services Task Force (USPSTF) guidelines (2012) recommended that most men need not be screened. So those men might be diagnosed for the first time when the cancer is in a later stage. However, the increase in aggressive prostate cancer started long before those guidelines were published.

2. Prostate cancer has just become more aggressive, but there is no data or even a hypothesis to explain why.

Neither of these reasons adequately explains why elderly men are now at higher risk for aggressive prostate cancer. So why am I including this study here? Finding prostate cancer in its early stages has been shown to greatly increase the chances of a cure or management. Once prostate cancer has metastasized cure is unlikely and management is much more difficult.

If you are older than 55 and have never been screened, it might be beneficial to you to consider being screened.

And, in direct opposition to these findings is the statement made by the President of The American Cancer Society, Dr. Otis Brawley. Dr. Brawley issued a statement: "This study makes a dramatic claim about an issue all of us have been watching eagerly: namely, whether less PSA screening might lead to more advanced cancers. But the current analysis is far from adequate to answer that question sufficiently. 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."  

I was diagnosed with prostate cancer more than 13 years ago. As someone who now has late stage prostate cancer (metastatic Castration Resistant Prostate Cancer) I know how difficult it is to manage and how expensive it is to treat. Early diagnosis likely made it possible for me to live this long. Nobody knows all the answers, yet. Stay tuned.

axman