Prostate Cancer Rates Rising: Here’s What You Should Know About Screenings, Risk Factors and More

When the American Cancer Society (ACS) recently released its annual report, the highlight was that overall cancer deaths continue to decline, dropping 33 percent since 1991.But there was one striking exception to the good news: The second-leading cause of cancer death for U.S. men, prostate cancer, increased 3 percent each year from 2014 through 2019 after two decades of decline, the ACS said.

Rohan Garje, M.D., the chief of genitourinary medical oncology at Baptist Health Miami Cancer Institute.

Moreover, rates of advanced prostate cancers are on the rise, likely driven by confusion and conflict over evolving screening guidelines from the U.S. Preventive Services Task Force, ACS officials stated.

The report stressed that there’s been a 5 percent year-over-year increase in diagnosis of men with advanced prostate cancer, “so we are not catching these cancers early, when we have an opportunity to cure men,” stated Karen E. Knudsen, M.D., ACs chief executive officer.

Rohan Garje, M.D., the chief of genitourinary medical oncology at Baptist Health Miami Cancer Institute, emphasizes the importance of all men beginning at age 40, to discuss prostate cancer risk factors, symptoms and screenings with their doctors.  

"To improve prostate cancer outcomes, we need to improve education of both patients and primary care physicians about screenings,” explains Dr. Garje. “The U.S. Task Force is not saying, 'Don't screen.' They are encouraging a shared decision. That is the key. That every patient, at whatever risk level -- average risk at 50 or 45, or even 40 with a strong family history or a genetic predisposition -- should have a discussion about screenings with their primary care or family physician."

Dr. Garje is the chair for the castration-resistant prostate cancer guidelines committee for the American Society of Clinical Oncology. He leads the committee’s work in reviewing research and writing guidelines for prostate cancer treatment. Dr. Garje clarifies that patients with prostate issues, whether benign or cancerous, will ultimately be referred to a urologist.

 “A urologist sees a patient only when they have some urological problem -- they don't get screened there for prostate cancer unless it is brought up,” said Dr. Garje. “But that is a very narrow group of patients who get screened for prostate cancer with a urologist. They usually come to my office after getting diagnosed with prostate cancer.”

But by then, the cancer may have advanced to a dangerous point, he adds, based on the trend noted by the ACS.

“Now, patients are coming up with lymph node metastasis and advanced stage disease,” said Dr. Garje. “So, a curable disease is turning into an incurable disease. And then we are talking about all kinds of treatments. Fortunately, there are many treatments available to help the patients with advanced prostate cancer, but advanced cases could be prevented with more earlier screenings.”

Clarifying Prostate Cancer Screening Guidelines

Recognized as the leading panel of experts on health screenings, the U.S. Preventive Services Task Force recommends that men between 55 and 69 years of age discuss the potential benefits of prostate cancer screenings with their doctor.  But the task force previously shed doubt on the routine blood test for prostate cancer, the prostate-specific antigen, or PSA. The test measures the level of PSA in the blood, referring to a protein produced by both cancerous and noncancerous tissue in the prostate.

In 2018, the task force reversed an earlier stance against the PSA blood test, citing mostly PSA tendencies to generate positive screening results (or “false-positive” results) in men without prostate cancer. The task force urges men to consult with their doctors about the PSA’s effectiveness. Nonetheless, there is still much confusion among men in that age group about the blood test’s accuracy.

There is no specific normal or abnormal level of PSA in the blood, explains the ACS.  In the past, PSA levels of 4.0 ng/mL and lower were considered normal. However, some individuals with PSA levels below 4.0 ng/mL have prostate cancer and many with higher PSA levels between 4 and 10 ng/mL do not have prostate cancer.

Guidelines from both the American Cancer Society and American Urological Association recommend that doctors discuss screening with men at an earlier age — 40 for those with a close relative who has had prostate cancer, 45 for men at high risk, and 50 for nearly all others. Men at average risk should start getting screened for prostate cancer by the age of 50. That includes the digital rectal exam performed by a primary care physician. The doctor feels your prostate for hard, lumpy, or abnormal areas. If a suspicious lump or area is detected, your doctor will recommend further testing.

“There are several organizations that provide guidance for prostate cancer screening” said Dr. Garje. “One is the Task Force (USPSTF), which has a broader audience of primary care physicians and patients.  And then there's the other side, which involves the American Urological Association, National Comprehensive Cancer Network and the American Cancer Society, which deal with cancer day-to-day and whose perspectives are more focused. There is no one answer to this situation. The primary thing is for men, depending on their risk levels, to have an open discussion with their primary care physician so they can fully understand the risks and benefits of prostate cancer screenings.”

Top Risk Factors for Prostate Cancer

All men are at risk for prostate cancer. About 13 out of every 100 American men will get prostate cancer during their lifetime -- and about 2 to 3 men out of 100 will die from the disease, states the U.S. Centers for Disease Control and Prevention (CDC) The most common risk factor is age -- the older a man is, the greater the chance of getting prostate cancer. The other top risk factors are a family history of prostate cancer and being African-American. 

“Black men, unfortunately, have a 70 percent increase in incidence of prostate cancer, compared to white men, and a two- to fourfold increase in prostate cancer [death rates] as related to any other ethnic group in the United States,” said Dr. Knudsen, of the ACS.

African-American men and Caribbean men of African descent are both more likely to develop prostate cancer. The reason why these men experience more instances of prostate cancer is not clear.

For some men, genetic factors may put them at higher risk if they have more than one first-degree relative (father, son, or brother) who had prostate cancer, including relatives in three generations on your mother’s or father’s side of the family.

To address the alarming trends in prostate cancer, particularly affecting men of color, the ACS is launching IMPACT, an initiative geared toward Improving Mortality from Prostate Cancer Together. "This groundbreaking initiative will leverage our unique organizational strengths to mobilize resources across advocacy, patient support and research," said Knudsen. "ACS is committed to utilizing a tripartite strategy to reverse prostate cancer disparities and reduce death rates from prostate cancer in all demographics and disparities for Black men by 2035."

Learn more about prostate cancer symptoms, screenings and treatments.