"Prostate cancer cases will inevitably increase, or even surge, as more men around the world move into middle age and older, so it's time to start making plans and taking action."Researchers such as Dr Nick James, Professor of Prostate and Bladder Cancer Research at the London Cancer Institute and chief oncologist at the Royal Marsden Cancer Centre, have published The Lancet's Major Report on Prostate Cancer.This is particularly important for low- and middle-income countries, which will first face a significant increase in the number of prostate cancer cases in the future.
The report predicts that the number of prostate cancer cases worldwide will increase from 1.4 million per year in 2020 to 2.9 million per year in 2040, with the largest increase in low- and middle-income countries.At the same time, the number of people dying of prostate cancer each year worldwide will increase by 85% in 20 years, from 375,000 in 2020 to nearly 700,000 in 2040.
"Because of missed diagnoses and missing data collection in low- and middle-income countries, the real numbers are likely to be much higher than recorded," said Nick James.
Continuous improvement of early detection plans
Currently, prostate cancer screening in high-income countries typically uses prostate-specific antigen (PSA) testing to measure levels of prostate-specific antigen proteins in the blood.However, prostate cancer, which is usually detected by a PSA test, may never cause symptoms and may not require treatment.
Furthermore, there is evidence that this testing program leads to over-testing of low-risk older men without increasing the detection rate of prostate cancer in high-risk younger men.
To this end, the researchers recommend using MRI scans combined with PSA testing to screen men at high risk of prostate cancer in high-income countries, such as those with a family history, African descent, and those with BRACA2 mutations.This approach can both reduce overdiagnosis and over-treatment and detect potentially fatal prostate cancer cases.MRI imaging is effective in cancer imaging and can be used to provide information on whether the disease is invasive and potentially life-threatening.
However, the researchers also said that prostate biopsy is more effective in identifying aggressive cancers, so MRI should not be used alone to examine high-risk men.
The effectiveness of population-level PSA testing has not yet been tested in low- and middle-income countries, where researchers believe cancer screening tests are needed as soon as possible."New approaches to early diagnosis are critical in low- and middle-income countries, where the majority of men detect metastatic cancers – advanced cancers that have spread to other parts of the body, often bones."
"We must encourage those who feel good but are at higher risk of getting tested to detect deadly prostate cancer as early as possible."Mobile clinics and mobile testing offer cost-effective solutions that combine physical examination and education." Nick James introduced an innovative UK outreach programme called 'The Man Van', which offers free PSA testing for high-risk men aged 45 and over in London.
The plan specifically involves driving a van with quick and easy detection tools directly to workplaces and communities, providing screening for people at high risk of prostate cancer.Nearly 100 men have been diagnosed with cancer on thousands of tests." Nick James believes the combination of education, outreach, testing and referrals used by The Man Van has the potential to succeed in low- and middle-income countries.
Enhancing medical capacity in low- and middle-income countries
The best treatment for prostate cancer requires professionals and infrastructure to support diagnosis, surgery and radiation therapy for organ-limited prostate cancer, as well as radiation therapy and endocrine therapy for metastatic cancer.
One of the main barriers to improving prostate cancer care in low- and middle-income countries is the lack of trained staff and professional infrastructure.These shortages aren't limited to prostate cancer, and a major Lancet surgical report in 2015 suggested that 90 percent of people in low- and middle-income countries don't have access to basic surgical care.
"Improving early diagnostic capabilities in low- and middle-income countries will increase the detection rate of early prostate cancer, further increasing the demand for surgery and radiation therapy."Urgent measures were therefore needed to improve the surgical and radiotherapy capacities of those countries.The report notes that the establishment of regional centers could provide the infrastructure needed to strengthen the training of specialists and improve patient access to radiotherapy and surgery.
For men with metastatic cancer, early diagnosis and early initiation of endocrine therapy will reduce deaths and prevent serious complications such as spinal compression pain and urinary retention, which can lead to infection and kidney damage.
Expanding multi-channel public education
In many low- and middle-income countries, the report recommends that prostate cancer-related programs use new technologies and channels, such as smartphones and social media, to raise awareness of the dangers and symptoms of prostate cancer among men and their families.
The report mentions Project PINK BLUE, an organization that runs a series of awareness-raising campaigns on breast, cervical and prostate cancer in Nigeria and offers free cancer screening.Many of the organization's projects utilize digital technology and involve prominent public figures and online influencers.
James N'Dow, Professor of Surgery at the University of Aberdeen, UK, said: "The rise in prostate cancer cases and deaths will have a significant direct impact not only on men's personal health but also on families in low- and middle-income countries.In low- and middle-income countries, men tend to be the main economic breadwinner of families, and if they die or become seriously ill, they can lead to significant financial hardship for families.If you prepare now for the coming surge in prostate cancer cases and focus on improving education and early diagnosis programs, these risks can be greatly mitigated.”
As for how future research on prostate cancer might be conducted, the report notes that current research on prostate cancer is focused on white men in Europe, and that most of the research is conducted in high-income countries.However, black men, especially those of West African descent, have a higher risk of prostate cancer than white or Asian men, for reasons that are unclear.Black men also have higher prostate cancer mortality rates, but it's unclear whether this is due to differences in incidence or other factors, such as biological differences in disease or social factors (such as poverty or racism)."This will require more data to identify the drivers behind these trends."
In particular, the report calls for early testing of prostate cancer screening, early diagnosis and treatment in low- and middle-income countries, and for mandatory recording of racial profiles in clinical trials.