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Countries should review testing for prostate cancer to focus more on vulnerable groups, scientists have urged, as new research predicts global deaths from the disease will almost double in 20 years.
Low- and middle-income countries must prepare to prevent a sharp rise in fatalities, while richer nations should pay more attention to young people at highest risk of the disease, according to research published Thursday.
The Lancet Commission paper highlights the urgency of reviewing diagnostic practices as the rise in prostate cancer cases is driven by rising life expectancy around the world.
“We will see large increases in cases in high-income countries and even larger increases in low- and middle-income countries, which are driven by aging populations,” said Nick James, the commission’s lead author and professor. at the British Institute of Cancer Research.
“The only thing you can do to mitigate the harm it will cause is to set up programs that diagnose it earlier to allow for early treatment.”
According to the Commission’s estimates, annual deaths due to prostate cancer will reach almost 700,000 by 2040, an increase of 85% compared to 2020. The number of cases will more than double to 2.9 million in the same period time.
The African and Caribbean regions recorded the highest prostate cancer mortality rates in 2020, with countries such as Zimbabwe, Barbados and Ivory Coast among the hardest hit. This reflects both the late diagnosis and the higher risk that black men appear to have of developing the disease, for reasons that are not yet well understood.
Prostate cancer accounts for nearly one-sixth of male cancers, making it the most common form of the disease in more than half the world’s nations. Over the past 30 years, deaths from the condition have declined in most high-income states, partly reflecting public health campaigns and increased testing.
According to the research, low- and middle-income countries will need to be prepared for the pressure that the expected increase in cases will place on healthcare resources. Measures could include expansions of diagnostic trends already in development, such as having nurses conduct tests and use artificial intelligence techniques to help analyze pathology results.
“Improved awareness programs are needed to better inform people about the key signs to look out for and what to do next,” said Professor James N’Dow, commission member and founder of Horizons Trust & Horizons Clinic in The Gambia. “Implementing them alongside investments in cost-effective early diagnostic systems will be critical to preventing deaths.”
High-income countries should reevaluate the use of on-demand blood protein testing for older men, under “informed choice.” The technique, known as prostate-specific antigen testing, has drawbacks such as reporting tumors that may never cause symptoms and require no treatment.
“Research shows that the PSA test, when used to screen in men without symptoms, is inaccurate,” said Naser Turabi, director of evidence and implementation at the charity Cancer Research UK, who was not involved in Lancet Commission research. “It can lead to overdiagnosis of low-risk prostate cancers, but it can also cause some high-risk cancers to be overlooked.”
Wealthier nations should spend more on public awareness campaigns and MRI scans for younger men who are at higher risk, the commission said. These would include people who have a family history of the disease, are of African descent or carry a genetic mutation known as BRACA2.
More research is needed among various ethnic groups to broaden understanding of prostate cancer beyond the results of studies based largely on data from white men, the commission added.