Prostate Cancer Tsunami Coming, Experts Caution

An “Inevitable” Global Surge in Prostate Cancer Predicted by 2040

The Lancet Commission on Prostate Cancer has warned that there will be a significant increase in prostate cancer cases and deaths worldwide by the year 2040. The commission predicts that the number of cases will double to 2.9 million, while deaths will increase by 85% to nearly 700,000. This surge is already underway in high-income countries like the United States and the United Kingdom, but it is expected to gain momentum in low- and medium-income countries.

Emphasis on Sustainable Development Goals (SDGs)

1. Goal 3: Good Health and Well-being
2. Goal 10: Reduced Inequalities

Meeting in Paris Highlights Acceleration of Prostate Cancer Cases

The commission made this announcement during a meeting of urologists in Paris, France. Dr. Nick James, the lead author of the Lancet report and a professor of prostate and bladder cancer research at The Institute of Cancer Research in London, explained that the surge in prostate cancer cases is partly due to the success of medical advancements. He stated that prostate cancer is more common as men age, and with an increase in the number of older individuals in both high- and low-income countries, the incidence of prostate cancer is expected to rise.

Importance of Prostate Cancer Screening and Treatment

The Lancet report emphasizes the need for prostate cancer screening for all men aged 50-70 years, as well as men of African origin aged 45-70 years in high-income countries. The report highlights the improved use of technologies like MRI and the growing evidence for the safety of active surveillance. However, the report also points out the misuse of prostate-specific antigen (PSA) screening, which has led to overdiagnosis and overtreatment. The authors suggest implementing harm-reduction strategies, such as restricting screening in older men and using secondary tests before biopsy, to improve outcomes.

Addressing Undertreatment and Inequities

The report highlights the widespread undertreatment of advanced prostate cancer, with only 30-40% of men in the United States receiving combination hormone therapy for metastatic disease. The authors stress the importance of implementing known effective treatments to improve outcomes. Additionally, the report acknowledges the higher risk of prostate cancer among men of African ancestry and calls for more research to include this population.

New Approaches for Early Diagnosis in Low- to Middle-Income Countries

The Lancet report suggests the need for new approaches to enable earlier diagnosis of prostate cancer in low- to middle-income countries, where most patients present with metastatic disease. Dr. Brandon Mahal, a co-author of the report and vice chair of research in radiation oncology at the University of Miami Sylvester Comprehensive Cancer Center, recommends pop-up clinics and mobile testing to encourage early detection in high-risk men who feel well.

Examples of Successful Outreach Programs

The report highlights successful outreach programs like The Man Van in England, which provided free health checks, including PSA tests, to high-risk men in London. By bringing testing directly to men at work and in the community, this program resulted in almost 100 cancer diagnoses in men who may have otherwise been diagnosed at a more advanced stage.

Preparing for the Future

The report acknowledges that the medical community worldwide is ill-prepared for the expected increase in prostate cancer cases. Dr. James suggests that increasing the use of nurses and artificial intelligence (AI) may help address this challenge. He mentions that in his own hospital, biopsies are already performed by nurses, and AI is highly effective in diagnosing prostate cancer. Additionally, smartphones and AI technology could be used in poorer countries to fill gaps in diagnosis and treatment.

James and Mahal reported no relevant financial conflicts of interest. Vickers reports royalties from 4Kscore.

Howard Wolinsky is a medical writer in Chicago.

SDGs, Targets, and Indicators

1. SDG 3: Good Health and Well-being

   • Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes, or chronic respiratory disease.

2. SDG 10: Reduced Inequalities

   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies, and practices and promoting appropriate legislation, policies, and action in this regard.
   • Indicator 10.3.1: Proportion of the population reporting having personally felt discriminated against or harassed in the previous 12 months on the basis of a ground of discrimination prohibited under international human rights law.

Analysis

The article addresses the issue of the global surge in prostate cancer cases and its impact on health and well-being (SDG 3). The predicted increase in cases and deaths highlights the need for prevention, treatment, and improved healthcare services to address this growing problem. The article also mentions the need to reduce inequalities in healthcare access and outcomes (SDG 10).

Based on the article’s content, specific targets under these SDGs can be identified:

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
2. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies, and practices and promoting appropriate legislation, policies, and action in this regard.

The article mentions several indicators that can be used to measure progress towards these targets:

• Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes, or chronic respiratory disease. This indicator can be used to track the progress in reducing premature mortality from non-communicable diseases, including prostate cancer.
• Indicator 10.3.1: Proportion of the population reporting having personally felt discriminated against or harassed in the previous 12 months on the basis of a ground of discrimination prohibited under international human rights law. This indicator can be used to assess the level of discrimination and inequalities in healthcare access and outcomes.

Table: SDGs, Targets, and Indicators

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Source: medscape.com

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