Planning for predicted worldwide surge in prostate cancer cases

By Melanie Hinze

Prostate cancer cases are expected to double worldwide between 2020 and 2040, according to the recently published Lancet Commission on prostate cancer.

The Commission reported projections of prostate cancer cases in 2040 on the basis of data for demographic changes worldwide and rising life expectancy, finding that the number of new cases annually would rise from 1.4 million in 2020 to 2.9 million by 2040.

‘This surge in cases cannot be prevented by lifestyle changes or public health interventions alone, and governments need to prepare strategies to deal with it,’ the Commission authors wrote.

Several recommendations for immediate and long­-term interventions to mitigate the global impact were identified and prioritised, including modifying diagnostic pathways to facilitate early detection of prostate cancer while avoiding overdiagnosis and overtreat­ment of trivial disease. The authors noted that the case for prostate cancer screening for all men aged 50 to 70 years in high income countries was strengthening with improved use of technologies such as MRI and growing evidence for the safety of active surveillance.

The Commission authors said late diagnosis was wide­ spread globally, but especially in low-­ and middle-­income countries (LMICs), highlight­ing the urgent need to set up systems for earlier diagnosis. They suggested trials of screen­ing in LMICs as a matter of urgency. Early diagnosis systems should incorporate mixes of personnel along with artificial intelligence to aid interpretation of scans and biopsy samples. They also suggested using smartphones and social media to raise awareness of prostate cancer.

Commenting on the findings, Clinical Associate Professor Jeremy Grummet, Urologic Surgeon, Prostate Cancer Specialist and Director of Urology at Alfred Health, Melbourne, said, ‘In Australia we are well positioned, with our access to MRI and our accept­ ance of active surveillance for low-­risk prostate cancer, to lead the world in optimal PSA/MRI screening for prostate cancer, while minimising risks of over­ diagnosis and overtreatment.’

He said that MRI was well­-established in Australia as a routine part of prostate cancer testing for men with elevated PSA, which reduced both unnecessary biopsies and detec­tion of indolent disease which did not need to be identified.

Associate Professor Grummet identified the lack of health literacy in some patients as a major obstacle to equity of access to PSA testing.

‘To reduce inequity of choice for patients to know their own risk of having prostate cancer, all men aged 50 to 70 years with a life expectancy of over 10 years should at a minimum be offered a PSA test every two years – not just those men fortunate enough to hear about PSA testing from their mates,’ he said.

Associate Professor Grummet said it was important that GPs were aware that MRI triaging of who needs a biopsy and active surveillance of lower risk forms of prostate cancer had mitigated the risks of PSA testing enormously in the last few years.

He noted that the Commis­sion had not addressed the advent of focal therapy in even further risk mitigation of treat­ ment harm. Using focal therapy, ‘prostate cancer could be destroyed with precision, spar­ ing normal prostate tissue and therefore keeping side effects common to traditional curative treatments to a bare minimum.’

He said long-­term data were awaited, so focal therapy was not yet an evidence­-based standard treatment option, but the short-term data were extremely promising.’

Lancet 2024;