One analysis predicts that prostate cancer cases will double, rising from 1.4 million annually in 2020 to 2.9 million in 2040. Low and middle income countries They will be the ones who see the biggest increase. This is what a group of experts warns in a report by the Journal Commission The lancet about this type of tumor.
The report, which will be presented at the European Association of Urology Congress (EAU 24) on April 6, estimates that the number of deaths per year from this type of cancer will increase by 85% in 20 years, from 375,000 deaths in 2020 Year 2020 by 2040 there will be almost 700,000. The actual figures are likely to be significantly higher than those based on Underdiagnosis and to missed opportunities for data collection in countries with fewer resources.
In fact, the study shows that the majority of deaths from this tumor will occur in these low- and middle-income countries. Deaths from prostate cancer have declined in most high-income countries since the mid-1990s.
“This tumor is already a leading cause of death and disability, accounting for 15% of all cancers in men. “It is the second leading cause of cancer death in men in the UK and the most common form of cancer in men in more than half the countries in the world.”
Accordingly Nick JamesCommission lead author, Professor of Prostate and Bladder Cancer Research at the Cancer Institute of London “As male populations continue to mature middle age and old age“There will inevitably be an increase in cases.” Therefore, it is necessary to start planning and implementing measures now, he adds.”
Improve early detection programs
James emphasizes that it is obvious that “early detection and awareness programs will help save lives and prevent health problems due to this type of tumor in the coming years.” “This is particularly true in low- and middle-income countries which will have the most cases in the future.”
In high-income countries, prostate cancer screening usually involves a blood test that measures levels of a substance called a protein Prostate-specific antigen (PSA).
However, PSA testing often detects a tumor that may never cause symptoms and may not require treatment. The current method of diagnosing prostate cancer in the UK and many other high-income countries is based on an “informed choice” PSA test: men over 50 who have no symptoms of the disease can have a PSA test after consulting their doctor the risks and benefits.
The Commission argues that there is evidence that this approach leads to over-testing in older, low-risk men, but does not increase screening in younger, higher-risk men.
The authors also warn of large differences in the likelihood of being diagnosed with an advanced tumor in men using the “informed choice” strategy of PSA testing. For example, the National Prostate Cancer Audit in the United Kingdom found that in 2022, one in eight men (12.5%) patients with this tumor will be diagnosed with advanced prostate cancer in London, while in Scotland more than 1 in 3 (35%) will be diagnosed first is diagnosed late.
The authors recommend using MRI in combination with a PSA test
Instead, experts recommend using Magnetic resonance in combination with PSA testing to screen high-risk men in high-income countries, e.g. B. Men with a family history of the disease, men of African descent and carriers of the disease. BRACA2 mutation.
They argue that this approach would reduce both overdiagnosis and overtreatment while detecting potentially fatal diseases. Magnetic resonance imaging (MRI) is effective in capturing images of cancers and can help determine whether the disease is aggressive and may threaten the patient’s life.
However, they add that biopsies are more effective at detecting aggressive cancers, so MRI alone should not be used to screen people at high risk of disease.
Specialized personnel and equipment
The report also highlights that optimal treatment requires specialized staff and infrastructure to support diagnosis. Surgery and radiation therapy for the treatment of localized prostate cancer as well as radiation therapy and hormone therapy for metastatic diseases.
One of the main barriers to better care for this cancer in low- and middle-income countries is the lack of trained staff and specialized facilities.
Expanding early diagnosis capabilities in these countries will increase early detection rates and further increase the demand for surgery and radiation therapy. Therefore, “urgent measures are needed to increase surgical and radiotherapy capacity in these countries.”
For men with metastatic disease, early diagnosis and initiation of hormone therapy will reduce deaths and prevent serious complications such as painful spinal cord compression and urinary retention, which can lead to infections and kidney damage.
Ethnic inequalities
The commission’s authors emphasize the need for further research to better understand prostate cancer in men of non-white European descent and to improve detection and treatment in these groups.
Research and knowledge about this type of tumor is largely focused on white individuals, and most studies have been conducted in high-income countries. However, that is black manparticularly those of West African descent, have one higher risk of developing prostate cancer than whites or Asiansalthough the reasons are unclear.
There is also a higher mortality rate from this type of cancer among black people. However, it is not known whether this is due to different case numbers or other factors, such as the different biology of the disease or social factors such as disadvantage or racism. More data is needed to identify the factors driving these trends.
The authors of the commission call for mandatory registration Ethnicity in clinical trials and that these reflect the ethnic mix of the populations studied to ensure that the results apply to all groups. The authors of the commission also call for essays that deal with this Screening, early detection and treatment of prostate cancer in low- and middle-income countries