The annual number of cases of prostate cancer is expected to increase from 1.4 million in 2020 to 2.9 million in 2040. Annual deaths would increase by 85% to nearly 700,000 over the same period, mainly among men in low- and middle-income countries.
These results come from an international analysis, presented in 39e European Congress of Urology which is currently being held in Paris (April 5-8, 2024).
The authors point out that the true numbers are likely to be much higher due to underdiagnosis and flaws in data collection.
Most of these deaths are expected to occur in low- and middle-income countries, they say, due to rising case numbers and rising mortality rates in these countries.
Indeed, deaths from prostate cancer have declined in most high-income countries since the mid-1990s.
An inevitable wave in the world
However, the aging of the population and the increase in life expectancy will lead to a growing number of elderly men in the years to come.
Since the main risk factors for prostate cancer – such as being 50 years or older and having a family history of the disease – are unavoidable, the authors of the Lancet publication believe that it It will not be possible to prevent the next wave of cases through lifestyle changes or public health interventions.
Professor Nick James, lead author of the Lancet Commission, researcher at the Institute of Cancer Research in London is therefore banking on “better early detection and education programs”.
How to manage the use of the PSA rate?
Furthermore, the Lancet Commission maintains that the current conception of prostate cancer screening remains problematic.
This is the so-called “informed choice” program: it is based in particular on the PSA test, a blood test which measures the levels of a protein called prostate specific antigen (PSA).
This approach is used in many high-income countries including France: men aged 50 or over without symptoms of the disease can request a PSA test (and the repeat of it in order to observe its progress), at their doctor after a discussion of the risks and benefits.
Depending on the PSA levels, a prostate biopsy may be prescribed to the patient, in order to attest to the presence or absence of a tumor.
But the Commission has a caveat, saying there is evidence to suggest that this approach leads to overuse of cancer therapies in older, low-risk men and, conversely, that it does not increase cancer detection. of the prostate in younger men at high risk.
Reach out to high-risk men
In high-income countries, the authors instead recommend early detection programs targeted at people at high risk (family history of the disease, African origin, BRACA2 genetic mutation), in particular by means of MRI imaging in combination with PSA tests.
In addition, one way to screen these men at risk would be, for example, to set up pop-up clinics and mobile tests.
One such experiment was carried out in the United Kingdom: the “Man Van” offered free health checks – including PSA tests – to high-risk men in London aged 45 and over, at work and in places of life.
Thousands of health checks have led to nearly 100 cancer diagnoses.
Sources: Press release UAE 24 Prostate cancer cases expected to double worldwide between 2020 and 2040, new analysis suggests; Urofrance, the website of the French Association of Urology, consulted on 04/05/24; Website of the National Cancer Institute (INCa, consulted on 04/05/24); Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit. BMJ. 2023 May 17;381:e071082; Cancer at Diagnosis in England NPCA: Short Report 2022/8th September 2022
