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“Prostate Cancer Cases Set to Double by 2040: Urgent Global Action Required”

Prostate cancer cases are expected to surge from 1.4 million annually in 2020 to 2.9 million by 2040, and deaths are predicted to rise by 85% to nearly 700,000 per year during the same period, according to a new analysis from The Lancet Commission on Prostate Cancer. This dramatic increase will disproportionately affect men in low- and middle-income countries (LMICs), where limited resources and late-stage diagnoses often result in higher mortality rates.

The Growing Burden of Prostate Cancer

Prostate cancer is already one of the most common and deadly cancers among men, accounting for 15% of all male cancer diagnoses globally. It is the second-leading cause of cancer deaths in men in the UK and is the most prevalent form of male cancer in more than half of the world’s nations. By 2040, the number of prostate cancer cases and related deaths is expected to rise dramatically, especially in LMICs, where most men are diagnosed at a later stage of the disease.

While deaths from prostate cancer have decreased in high-income countries (HICs) since the 1990s, due to improved detection and treatment, the situation is worsening in LMICs. The report highlights that this disparity is driven by factors like limited access to early diagnosis and treatment, as well as the lack of awareness about the disease in many parts of the world.

Key Factors Behind the Surge

Several factors are contributing to the expected rise in prostate cancer cases:

  • Ageing populations: As life expectancy increases, more men are living into old age, a major risk factor for prostate cancer.
  • Genetic predispositions: Men over the age of 50, especially those with a family history of prostate cancer, are at higher risk.
  • Lack of effective screening in LMICs: Many men in these regions are only diagnosed once the cancer has already spread to other parts of the body, making it much harder to treat.

The commission warns that lifestyle changes or public health interventions alone cannot prevent this surge. Instead, attention must be focused on improving early detection and treatment, especially in LMICs, where infrastructure and medical capacity are often insufficient to handle the increasing demand.

Current Screening Practices and Their Limitations

In high-income countries, prostate cancer screening usually involves the prostate-specific antigen (PSA) test, a blood test that measures the level of a protein produced by the prostate gland. While PSA testing has been common, it often results in over-diagnosis and over-treatment in older men at low risk for aggressive disease, while under-testing younger men who are at higher risk. This practice has led to varying rates of late-stage diagnosis within HICs themselves. For instance, in 2022, 12.5% of men diagnosed with prostate cancer in London were diagnosed at an advanced stage, compared to over 35% of men in Scotland.

The commission advocates for more effective screening methods, such as combining PSA testing with MRI scans for men at higher risk (e.g., those with family history, African descent, or carrying the BRCA2 mutation). MRI scans can better differentiate between aggressive, life-threatening cancers and those that are less likely to cause harm. However, biopsies are still necessary to confirm diagnosis.

Challenges and Opportunities for LMICs

The need for prostate cancer screening in LMICs is urgent. Most men in these regions are diagnosed with metastatic cancer, meaning the disease has already spread by the time they seek medical help. As a result, survival rates are much lower compared to men diagnosed at an earlier stage. This late-stage diagnosis is a key reason for the predicted rise in prostate cancer deaths in LMICs.

The commission emphasizes the importance of implementing cost-effective and scalable early detection programs in these countries. Outreach initiatives like mobile testing clinics could be a solution. For instance, the UK’s “Man Van” initiative provided free health checks and PSA tests to high-risk men in London, resulting in early diagnoses for many men who might not have otherwise sought medical help. This model could be adapted for LMICs to improve early diagnosis.

The Need for Education and Awareness

Raising awareness about prostate cancer, especially its advanced stages, is critical for improving outcomes in LMICs. Many men in these countries are unaware of the symptoms of metastatic prostate cancer, such as bone pain, and may not realize that treatments like hormone therapy can help prolong life and reduce suffering.

The report points to successful educational initiatives like Nigeria’s Project PINK BLUE, which uses digital technologies and celebrities to raise awareness of prostate, breast, and cervical cancers. These types of programs could be key to educating men in LMICs about the importance of early diagnosis and available treatments.

Addressing Ethnic Inequities in Prostate Cancer Care

The commission also calls for more research into prostate cancer in men from diverse ethnic backgrounds, particularly those of West African descent, who are at higher risk of developing the disease. Currently, most prostate cancer research focuses on white men, leaving gaps in understanding how the disease affects other populations.

To address this, the commission urges that future clinical trials include mandatory recording of participants’ ethnicity to better understand how prostate cancer presents in different ethnic groups. This research is especially important for identifying and addressing disparities in care and outcomes among Black men, who tend to have higher mortality rates from prostate cancer.

Building Capacity in LMICs

One of the biggest challenges facing prostate cancer care in LMICs is the lack of trained healthcare workers and specialist facilities for diagnosis, surgery, and radiotherapy. These shortages are not limited to prostate cancer and are symptomatic of broader healthcare system deficiencies in these countries. For example, the 2015 Lancet Commission on Surgery found that 9 out of 10 people in LMICs lack access to basic surgical care.

The commission suggests creating regional hubs to train specialists and provide access to necessary treatments, such as surgery and radiotherapy. Earlier diagnosis and treatment, including hormone therapy, could prevent severe complications like spinal cord compression and kidney damage, which are common in men with late-stage disease.

Preparing for the Future

The looming surge in prostate cancer cases underscores the need for urgent global action, especially in LMICs. As Professor Nick James, lead author of the commission, notes: “We know this surge in cases is coming, so we need to start planning and take action now.” Improved screening, education, and access to treatment can help reduce the burden of prostate cancer and save lives.

By focusing on early detection, raising awareness, and improving treatment capacity, countries can better prepare for the challenges ahead. Without these efforts, the economic and social impact of rising prostate cancer cases, especially in LMICs where men are often the main breadwinners, could be devastating for families and communities.

In conclusion, as global populations age, prostate cancer will become an even more pressing public health issue. Now is the time to invest in the tools, education, and infrastructure necessary to meet the growing demand for prostate cancer care worldwide.

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