Prostate cancer is the most common among men, and according to scientific predictions, the number of cases will explode in the coming years due to the aging of the population.
The numbers look scary. A study published in The Lancet predicts that the number of prostate cancers will explode by 2040 in the world. “The annual number of new cases will double from 1.4 million in 2020 to 2.9 million in 2040,” the authors of the analysis wrote last year.
This trend could be explained by the increase in life expectancy. Poor or developing countries should therefore be particularly affected, as they are catching up in this area with so-called “developed” countries. The number of people aged 65 or older worldwide is expected to more than double, from 761 million in 2021 to 1.6 billion in 2050, according to UN projections.
Prostate cancer is already one of the most common among men. In Belgium, he represents 16% of male cancersaccording to data from the Cancer Foundation. It mainly occurs after the age of 50. Those aged 71-80 are the most affected (4,881 cases out of 12,699 in 2022).
An inevitable cancer
Old age is indeed the main risk factor. THE family history also come into play in 20% of cases. The risk of developing prostate cancer as we age is two to three times higher in men whose father, brother and/or uncle have already suffered from this disease. But lifestyle has very little effect, underlines Philippe Westerlinck, oncologist at Liège University Hospital. “Less than 1% of prostate cancers can be prevented. The only advice to give would be to eat tomatoes. Funny? Studies have shown that regular tomato eaters have up to a 20% lower risk of developing prostate cancer, due to its concentration of lycopene, a powerful antioxidant. To benefit from the effects, you would have to ingest two large tomatoes per dayor 1.5 kilos per week.
Almost all men will develop prostate cancer if they are lucky enough to get old enough
The prostate problem is not expected to improve, since life expectancy, which is currently 80.4 years for men, would increase to 86.6 years in 2040according to Stabel forecasts. “We could almost – the almost is important – say that all men will develop prostate cancer if they are lucky enough to age sufficiently,” says the oncologist.
The majority of prostate cancers are not aggressive
Is it serious, doctor? “It is especially in the countries of Asia and Africa that the prevalence will increase artificiallybecause they are starting to screen,” says Professor Bertrand Tombal, head of the urology department at the Saint-Luc University Clinics. As screening has already been well organized for around thirty years in the flat country, “there will certainly be no major impact on public health”.
Especially since the majority of prostate cancers are indolents. “Out of 100 healthy men, around 20 will have prostate cancer, and among these 20 cases, there will only be four or five who will be aggressive. When choosing a cancer, you might as well take that of the prostate,” quips the urologist. In Belgium, only 1.7% of people who developed prostate cancer died within five years. “More than half of men over 80 may die with prostate cancer without ever knowing it, and without it being the cause of their death. You can live with it very well without having symptoms, assures Doctor Westerlinck. However, we must not deny that there are people who die from it.”
Too much screening, too many cancers
The Belgian healthcare system is too proactive in the search for prostate cancer, Professor Tombal also believes. The test in use for around thirty years is the measurement of the level of PSA (Prostate Specific Antigen), a prostate protein, in the blood. A high level indicates an abnormality in the prostate, but this is not necessarily cancer. If there is cancer, it is often detected at an early stage, even before symptoms appear. It’s a «surdiagnostic»which leads to a “overtreatment”. As most cancers detected at this time are indolent, “patients should be recommended to do nothing and just actively monitor their condition. There is no need to worry the patient with a cancer which is not likely to impact their survival. Especially since the treatments cause side effects, such as incontinence or erectile dysfunction.
Since 2012, national scientific recommendations have moved in the direction of surveillance, “but it doesn’t work”. The problem is that the doctors are “funded on a fee-for-service basis in Belgium. However, with a well-conducted screening strategy, which would only target the few aggressive prostate cancers, the figures could decrease, says Bertrand Tombal, who advocates for this the systematic use of prostate MRI after a PSA test, rather than going directly at the biopsy.
