Prostate cancer cases to double between 2020 and 2040, deaths to rise by 85 per cent: Lancet study

Prostate cancer cases worldwide are projected to more than double and deaths to increase by 85 per cent between 2020 and 2040, with low- and middle-income countries (LMICs) likely to bear the ''overwhelming brunt'' of this spike, according to The Lancet Commission on prostate cancer.

The surge in cases is ''inevitable'', with actual numbers likely to be much higher because of under-diagnosis and missed opportunities for data collection in LMICs, researchers said.

They said ageing populations and improving life expectancy will lead to more cases of prostate cancer in older men, and given than being 50 years or older is a risk factor, lifestyle changes and public health interventions may not be able to prevent the upcoming surge.

''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,'' said lead author of the Commission, Nick James, professor of prostate and bladder cancer research at The Institute of Cancer Research, London, UK.

The commission called for evidence-based interventions, including early detection and diagnosis, along with education and awareness programmes, to help save lives from prostate cancer in the coming years.

''This is especially true for low- and middle-income countries which will bear the overwhelming brunt of future cases,'' said James.

The authors called for improving the ''poor'' levels of awareness in LMICs about the dangers and symptoms of metastatic prostate cancer, such as bone pain, among men and their families.

''One of the common pains in prostate cancer comes from spine metastasis, where the cancer spreads to the spine. While this usually presents in the later stages of the disease, it could even be the presenting symptom. Other pains may be associated with urination or treatment, such as post-surgical or chemotherapy-induced pain,'' said pain specialist Dr Lakshmi Vas, director of the Ashirvad Institute for Pain Management and Research, Mumbai.

''The pain experienced in prostate cancer is intense, reaching the very depths of the bones forming the axial skeleton, including the spine, ribs and the pelvis,'' said Dr Mary Abraham, senior consultant, pain and palliative care at the Max Institute of Cancer Care, Lajpat Nagar, New Delhi.

Similarly, there is a low general awareness that treatments available in LMICs can prolong survival and decrease suffering, including cheap, effective ones such as hormone therapy, the authors said.

Acknowledging the ''fear of suffering'' that comes with cancer diagnosis, Vas advocated for consulting with a pain specialist.

''The greatest fear is the suffering associated with cancer and patient education in this regard is very vital. I strongly suggest that right after being diagnosed with prostate cancer, take an appointment with a pain specialist. This way the patients can be reassured that pain management is possible whatever the stage of cancer might be, and also for other pains that come with cancer treatments. Forewarned is forearmed, after all,'' said Vas.

As with early diagnostic capacity, there is a need to scale up availability and improve access to treatments for advanced disease in LMICs, the authors said.

Abraham said awareness in men regarding prostate enlargement, along with regular screening, was important.

''Men need to be made aware about benign vs cancerous enlargement of the prostate gland. While the vast majority of men aged 50 years and above have an enlarged prostate, it is usually benign, called benign prostate hypertrophy (BPH). BPH is not linked to cancer and does not increase the risk of prostate cancer,'' she said.

However, PSA testing is advised as it is the single most recommended test for the early detection of prostate cancer, Abraham said. The PSA test screens the blood sample for prostate cancer.

According to the guidelines of the American Urological Association and the National Comprehensive Cancer Network (NCCN), a single baseline PSA test is done for all men aged 40-45 years, and then yearly testing in higher risk men over the age of 45 years.

Globally, the study estimated yearly cases of prostate cancer to be 14 lakh and yearly deaths due to the disease to stand at 3.75 lakh in 2020. The prostate cancer cases are projected to rise to 29 lakh a year and almost seven lakh prostate cancer deaths a year by 2040.

The commission includes researchers from the International Agency for Research on Cancer (IARC), an inter-governmental agency forming part of the World Health Organisation.

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