Movember 2022: Age Trends in Prostate Cancer Mortality
Government recommendations are not always in your personal best interests
In my last post on Movember and prostate cancer, I noted that progress in mortality improvement in prostate cancer may have stalled out. Let’s dig deeper into the age-level trends and see if we can find something there.
Movember Fundraiser
First, here are the places you can donate to the Movember Foundation, which supports men’s health, specifically focusing on prostate cancer, testicular cancer, and men’s mental health:
Mary Pat Campbell’s MoSpace – a place to donate at Movember itself
My Movember Facebook fundraiser – my officially linked fundraiser, if this works better for you
Those are the two official links I have via Movember, and they’ve given me “official assets” to play with to promote the fundraiser, as I’ve raised over $6,600 for the org since 2017.
I often have to trick Stu into taking pics with me… usually by looking silly myself. At the end of the post, I will provide a fundraiser update.
Age-related trend – worse, then better
I like providing the longest-term trend I can find, and that is going back to 1968.
So you can see the increase in prostate cancer mortality, up to the early 1990s, for the oldest men. I think part of that is related to the reduction in smoking in men — when one thing stops killing a group as much, well, something is going to get you, you know. So heart disease and lung cancer were dropping as a result, and other causes of death took their place.
But it was cancer screening, and the PSA test in particular, that really helped cut down prostate cancer mortality past the 1990s. In a paper from 2015:
In the early 1990s, it was first demonstrated that the PSA blood test could be used as a first-line screening test for prostate cancer [21], which led to the approval of the PSA test by the United States Food and Drug Administration (FDA) as an aid to the early detection of prostate cancer [22]. PSA derivatives, such as PSA velocity [23], PSA density [24], [25], and the free-to-total PSA ratio [26] (also FDA approved) served to improve the accuracy of PSA testing. More recently, other PSA isoforms, such as the [-2]proPSA, have been found to be a more cancer-specific biomarker for prostate cancer, which has led to FDA approval of the Prostate Health Index (PHI) in 2013 [27].
4. PSA testing reduces prostate cancer-specific mortality
During the “PSA era” in the United States, the proportion of patients having advanced disease at diagnosis has decreased by 80%, and the age-adjusted prostate cancer mortality rate has decreased by more than 42% [28]. Statistical modeling studies have estimated that 45%–70% of this mortality decrease is attributed directly to PSA screening [29], [30]. Similar trends have been observed in countries that have adopted widespread PSA screening but not in those that have not adopted PSA screening [31]. Two large prospective, randomized clinical trials in Europe have demonstrated a 21% and 44%, respectively, decrease in prostate cancer-specific mortality associated with PSA screening [32], [33].
You can go to the link to check out all the references I’m not linking.
Here’s an updated graph showing the decade-by-decade change in mortality rates:
To make it clear — positive is bad – which means mortality went up. Negative is good – mortality went down.
There were very large improvements from 1991 to 2001, and from 2001 to 2011.
However, our most recent decade shows a fizzling, and you can see for age group 65-74 years that improvement has completely disappeared.
What’s up?
The stalling in mortality related to a stalling in routine PSA screening
The following post does not have a date on it, but 5 Years After Guidelines Recommend Against Routine Prostate Cancer Screening, Later Stage Cancers Continue to Increase—for Unknown Reasons seems pretty clear to me:
The Challenge: In 2008, the US Preventive Services Task Force (USPSTF) recommended against regular prostate- specific antigen (PSA) screening for men age 75 and older, and 4 years later, in 2012, they recommended against routine PSA screening for all men. (See current ACS recommendations for prostate cancer early detection.)
Since then, using data through 2015, studies have reported that incidence rates for prostate cancer confined to the prostate (local-stage disease) have declined, but incidence rates have increased for prostate cancer that’s spread to areas near and far from the prostate, known as regional- and distant-stage disease, respectively.
However, those studies did not include the most recent data available through 2016.
As I have mentioned, Stuart has advanced prostate cancer (distant-stage disease) — it wasn’t detected until it had spread all throughout his body, and most importantly, into his bones, and it’s not coming out of his bones.
You would much rather have prostate cancer detected when it’s still in your prostate, men.
I assume the American Cancer Association is trying to be diplomatic here, but yeah, there is a cause-effect link.
Jemal and his team found that from 2007 to 2016, for men of all races and ethnicities age 50 and older, prostate cancer incidence rates continued to decline when the cancer was localized or still confined to the prostate. For men age 75 and older, the rates stabilized during 2013 to 2016.
But for men age 50 and older, during the same time span, the incidence rate persistently increased when cancer had spread—near or far—from the prostate.
These data illustrate the trade-off between higher screening rates and more early-stage disease diagnoses—possibly overdiagnosis and overtreatment—and lower screening rates and more late-stage—and possibly fatal—disease, the authors said.
For instance, they found that for men ages 50 to 74, a substantial decline in racial disparity in the incidence of advanced disease for men coincided with a steeper increase in advanced cancer incidence in White men. In other words, after the change in screening guidelines, the incidence rate for White men rose to match the incidence rate for Black men.
Still, compared to White men age 75 and older, incidence rates for more advanced stage prostate cancer was 65% higher in Black men of that age. The researchers don’t fully understand the reason for this disparity continues to exist. They think it may partly reflect differences in lifestyle factors, biological susceptibility, and access to quality care.
I will be coming back to the racial disparities in a later post, because it’s stark.
As for the reasons for changing the screening guidelines…. well. Anyway, you can see that the statistics are fairly old.
But here’s the bottom line: the cancer screening guidelines may not be in your personal, best interests, so you may need to consider your own, personal risk factors. From direct familial experience, you want to detect cancer before it’s gotten into your bones.
I understand the original thinking of the changing in the screening recommendation, in that some prostate cancers really are slow-growing and the men would likely die of something else before the cancer gets anywhere.
Except that men are living to much older ages now, and cancer treatments are changing all the time. I think it’s foolish to be making cancer screening recommendations based on expectations that may be out-of-date fairly soon after you have made them.
And, it seems like a decade after this recommendation change was made, there have been noticeable effects. Maybe you should ignore the recommendation for yourself if you have any risk of prostate cancer.
Movember fundraiser update
Whoaaaa, we’re halfway there!
Not too shabby…. now, don’t hold off til Giving Monday (or whatever they call it). I’d like to reach my goal ($2K) as soon as can be, of course. I mean, look at that growth!
So you don’t have to scroll up, here are my fundraiser links again:
They both link to the same fundraiser.
Thanks!
