Incidence of prostate cancer is decreasing – or is it?

On June 12th, 2017, Fadi N. Joudi, MD, FACS published in The Wichita Eagle –

Prostate cancer is the most common cancer in men. An estimated 241,470 cases were diagnosed in the U.S. in 2012, and it is estimated that 161,360 cases will be diagnosed in 2017.

But is the incidence of prostate cancer really decreasing? The answer is no. It is just not being diagnosed as much due to decreased screening practices.

Screening for prostate cancer consists of an annual digital rectal exam and a simple blood test: prostate-specific antigen, or PSA. While screening for prostate cancer has been a point of controversy, the American Urological Association recommends screening for men ages 54 to 69 and starting at age 40 for African-American men and men with a family history of prostate cancer.

In 2008, the United States Preventive Services Task Force recommended against PSA screenings for men older than 75, and in 2012, they recommended against screening for all ages, saying that the test leads to overdiagnosis and overtreatment. These recommendations led to decreased rates of screening for prostate cancer.

These blanket recommendations, while they can help avoid overdiagnosis and possibly overtreatment of low-risk prostate cancer, are leading to underdiagnoses or delayed diagnoses of intermediate-risk or high-risk prostate cancer patients. In fact, a recent study evaluating patients between 2004 and 2013 found an increased incidence of advanced and metastatic prostate cancer in men over 75 following a nadir in 2011.

When assessing the impact of prostate cancer, scientists evaluate whether patients are more likely to die from prostate cancer compared with other causes. Since prostate cancer is generally slow growing, studies need long-term followup. Another important outcome is the morbidity of the disease, which reflects the effect of advanced disease (pain from metastatic disease to the bone, difficulty voiding).

A recent randomized trial published in the New England Journal of Medicine evaluated more than 82,000 patients ages 50 to 69 that were divided into three groups: actively monitored vs. surgery vs. radiation. After an average 10-year followup, they found no difference in mortality among the three groups. However, those who were in the surgery and radiation group had lower incidence of disease progression and metastases compared to those in the actively monitored group.

The USPSTF has just released a draft recommendation that encourages clinicians to discuss the benefits and harms of PSA screening in men ages 55 to 69. Although this new draft recommendation does not address high-risk patients and men younger than 40, this is a good start.

Urologists have addressed the shortcomings of PSA tests by smarter screening (screen only patients who have good life expectancy) and using certain new tests to help decide who to biopsy. New technologies in imaging, like MRI and genetic tests, are being introduced to help with diagnosis and treatment decisions for patients with low- to intermediate-risk prostate cancer. Active monitoring has evolved as a viable treatment option for low-risk prostate cancer patients, addressing the issue of overtreatment. The key words here are “low risk,” and without a biopsy, one cannot know whether a patient has low- or high-risk prostate cancer. Avoiding screening will lead to high-risk patients that will go undiagnosed and present with advanced disease. For men ages 54 to 69, a frank discussion with your primary care physician is a good start.

Wichita Urology Group advises the public of fraudulent phone calls masked with Wichita Urology Group numbers. The scammers behind these fraudulent calls are posing as employees of Wichita Urology and pretending to have sensitive information about the receiver. While Wichita Urology employees might call patients to schedule appointments or answer billing information, those employees won’t ask patients to pay to gain access to their information or ask them about their sensitive information.

Wichita Urology Group advises the public of fraudulent phone calls masked with Wichita Urology Group numbers. The scammers behind these fraudulent calls are posing as employees of Wichita Urology and pretending to have sensitive information about the receiver.
While Wichita Urology employees might call patients to schedule appointments or answer billing information, those employees won’t ask patients to pay to gain access to their information or ask them about their sensitive information.