Screening and treatment guidelines may need to be intensified because rates of metastatic prostate cancer have increased by nearly three-quarters during the last decade, researchers suggest after a recent study.
Researchers at Northwestern University report more men with metastatic prostate cancer are being diagnosed with worse and more aggressive tumors, raising concerns about surveillance and diagnosis for an incurable form of the disease.
Even significantly aggressive localized prostate cancer can be treated and cured, but metastatic prostate cancer treatment does not cure the disease — treatment slows progression of the disease but patients eventually die.
“The results indicate that screening guidelines and treatment need to be refined based on individual patient risk factors and genetics,” Dr. Adam Weiner, a Feinberg urology resident at Northwestern’s School of Medicine, said in a press release. “This may help prevent the growing occurrence of metastatic prostate cancer and potential deaths associated with the disease. This also can help minimize overdiagnosing and overtreating men with low-risk prostate cancer who do not need treatment.”
For the study, published in the journal Prostate Cancer and Prostatic Diseases, researchers analyzed medical data on 767,550 men diagnosed with prostate cancer at 1,089 facilities between 2004 and 2013.
Overall, the number of patients diagnosed with metastatic prostate cancer increased more than 72 percent, while the incidence of low-risk prostate cancer decreased by 37 percent.
During the same period, the number of metastatic prostate cancer patients between the ages of 55 and 69 increased by 92 percent.
Men with metastatic disease had higher PSA levels than similar men in 2004, which suggests the more aggressive disease is becoming more common, but researchers say the large increase in older patients with worse disease may be catchable with changes in screening.
Without data to back up the theory, however, researchers say they are sure of only one thing: Worse prostate cancer is becoming more common.
“One hypothesis is the disease has become more aggressive, regardless of the change in screening,” said Dr. Edward Schaeffer, chair of urology at Northwestern University Feinberg School of Medicine. “The other idea is since screening guidelines have become more lax, when men do get diagnosed, it’s at a more advanced stage of disease. Probably both are true. We don’t know for sure but this is the focus of our current work.”