Prostate cancer cases to double worldwide between 2020 and 2040 – study

The authors advocate for early-detection programmes for those at high risk (Peter Byrne/PA) (PA Wire)

Prostate cancer cases are expected to double worldwide between 2020 and 2040, new analysis suggests.

The data suggests annual prostate cancer cases are projected to rise from 1.4 million in 2020 to 2.9 million in 2040.

And annual deaths from the disease are projected to increase by 85% to almost 700,000 over the same timeframe, mainly among men in low- and middle-income countries (LMICs).

Ageing populations and increasing life expectancy will lead to higher numbers of older men in coming years.

As more and more men around the world live to middle and old age, there will be an inevitable rise in the number of prostate cancer cases

Professor Nick James

The main risk factors for prostate cancer – such as being aged 50 or older and having a family history of the disease – are unavoidable, so it will not be possible to prevent the upcoming surge in cases through lifestyle changes or public health interventions, the researchers suggest.

The Lancet Commission on prostate cancer argues that the informed choice programme for prostate cancer screening with testing, which is common in high-income countries (HICs), may lead to over-testing and unnecessary treatment in older men, and under-testing in high-risk younger men.

Instead, the authors advocate for early-detection programmes for those at high risk.

The commission also calls for urgent programmes to raise awareness of prostate cancer and for improvements in early diagnosis and treatment in LMICs.

More research involving men of different ethnicities, especially those of West African descent, is needed, the researchers say.

Prostate cancer is a major cause of death and disability, accounting for 15% of all male cancers.

In the UK it is the second most common cause of cancer deaths in men and the most common form of male cancer in more than half of the world’s countries.

With prostate cancer we cannot wait for people to feel ill and seek help – we must encourage testing in those who feel well but who have a high risk of the disease in order to catch lethal prostate cancer early

Professor Nick James

Data suggests there were 56,780 estimated prostate cancer cases in 2020 and this is predicted to increase to 75,066 cases by 2040 (if incidence rates stay the same), a 32% increase over 20 years.

If there was a 1% decline per year until 2040, as is predicted for the Northern Europe region in the study, the predicted number in 2040 would still increase to 61,397 new cases, an 8% increase over 20 years.

With an annual 1% increase in cases, the predicted number would be 91,544 in 2040, a 61% increase over 20 years.

Nick James, lead author of the commission, Professor of prostate and bladder cancer research at the Institute of Cancer Research, London, said: “As more and more men around the world live to middle and old age, there will be an inevitable rise in the number of prostate cancer cases.

“We know this surge in cases is coming, so we need to start planning and take action now.

“Evidence-based interventions, such as improved early detection and education programmes, will help to save lives and prevent ill health from prostate cancer in the years to come.

“This is especially true for low- and middle-income countries which will bear the overwhelming brunt of future cases.”

In HICs, screening for prostate cancer often involves the PSA test, a blood test that measures levels of a protein called prostate-specific antigen (PSA).

The current approach to prostate cancer diagnosis in the UK and many other HICs relies on “informed choice” PSA testing.

Men aged 50 or over with no symptoms can request a PSA test from their doctor after a discussion of the risks and benefits.

According to the commission, there is evidence to suggest this approach leads to over-testing in low-risk older men but does not increase detection of prostate cancer in younger men at higher risk.

Instead, the authors recommend using MRI scans in combination with PSA testing to screen men at high risk of prostate cancer in HICs.

This includes those with a family history of the disease, those of African origin and those carrying the BRCA2 mutation.

The experts say new approaches are needed to enable earlier diagnosis in LMICs, as most men in these countries present with an advanced form of disease where the cancer has spread to other parts of the body, often the bones.

Men with late-stage prostate cancer are much less likely to survive for a long period of time than those who are diagnosed early.

Prof James, who is also a consultant clinical oncologist at the Royal Marsden NHS Foundation Trust, added: “With prostate cancer we cannot wait for people to feel ill and seek help – we must encourage testing in those who feel well but who have a high risk of the disease in order to catch lethal prostate cancer early.

“Pop-up clinics and mobile testing offer cost-effective solutions that combine health checks and education.”

The experts suggest that a major barrier to improved prostate cancer care in LMICs is a lack of trained staff and specialist facilities.

Urgent measures are therefore needed to build surgical and radiotherapy capacity in these countries, they say.

This study reflects the impact of a growing, ageing population on rising numbers of people being diagnosed with prostate cancer worldwide

Naser Turabi, Cancer Research UK

Alfred Samuels, 66, is a black man who was diagnosed with stage 4 advanced prostate cancer at the age of 54.

He said: “This report has been a long time coming.

“I wholeheartedly agree that we need a targeted approach to screen those at higher risk, such as black men – this would be invaluable.

“Due to the late stage that my prostate cancer was diagnosed, I wouldn’t be here today if I hadn’t been able to access a clinical trial – it was my lifeline.

“Now, it needs to be mandatory to record ethnicity in clinical trials, and trials must reflect the ethnic diversity of the population, so that we can find better treatments for people like me.”

The commission will be launched at the 39th Annual European Association of Urology Congress on Saturday.

Cancer Research UK’s director of evidence and implementation, Naser Turabi, said: “This study reflects the impact of a growing, ageing population on rising numbers of people being diagnosed with prostate cancer worldwide. Here in the UK, cases have risen by around 150% in the last 25 years.

“We support the Lancet’s call for more research into the early detection of prostate cancer. Cancer Research UK is funding studies to help us find ways of accurately diagnosing the disease early, and we also have trials taking place to find the best treatment for men with prostate cancer.”