A paper just published in the Journal of Clinical Oncology ( and available in full on line) includes data projecting 382,000 new cases of prostate cancer in the USA in 2030.
According to this study by Smith et al., we should be expecting a massive increase in the number of cancer cases in the USA over the next 20 years, based on the aging of the “baby boom” generation (which includes your editor). With respect to prostate cancer, the data projected by Smith and his colleagues are as follows:
- In 2010, 246,000 new diagnoses, with 182,000 in men ≥ 65 years of age
- In 2020, 322,000 new diagnoses, with 252,000 in men ≥ 65 years of age
- In 2030, 382,000 new diagnoses, with 310,000 in men ≥ 65 years of age
Now projecting cancer incidence and mortality rates has always been a risky business, and it has to be said that the oncology community has tended, over the years, to present cancer statistics in ways that can be wildly over-interpreted. So, let’s see if we can put some perspective around these numbers.
First, we are assuming that we will get better at identifying cancer earlier. It is likely, today, that we only identify about half of the prostate cancers that men actually have, because lots of men undoubtedly pass away with prostate cancer that was never diagnosed. Why, because:
- They never got tested at all, or
- They never got a biopsy because of their age by the time they got a PSA of (say) 4.0 ng/ml, or
- They never even saw a doctor until the idea that they might have prostate cancer was irrelevant by comparison with other clinical problems of aging.
If we could identify every man today, who actually had a tumor in his prostate of (say) 0.4 cm3 or larger, my bet is that we would already be diagnosing 300,000 cases of prostate cancer a year in the USA — but there would still only be about 28,000 to 30,000 men dying of this disease.
Second, we know that a large percentage of men diagnosed today with prostate cancer actually have clinically insignificant disease. No one can tell us exactly what percentage of men have disease that will never really bother them at all (i.e., disease that really is clinically insignificant and has no symptoms whatsoever) but it may be somewhere between 20 and 30 percent of all patients currently diagnosed. So if we get better at diagnosing the presence of prostate cancer without coming up with better tests to differentiate between men with disease that is likely to be clinically significant and disease that is almost certainly clinically insignificant, we are at risk for spreading a vast amount of anxiety without actually helping very many men at all.
The “New” Prostate Cancer InfoLink does believe that a diagnosis of prostate cancer will become significantly more common over the next 20+ years. However, we also believe that the vast majority of this increased number of diagnoses will be from cases of indolent disease, which makes it very important that we find a way to ensure:
- That we implement appropriate prostate cancer prevention strategies for those men at highest risk for clinically significant disease
- That we discover much better (and preferably non-invasive) tests for the diagnosis of prostate cancer by risk category, and soon
- That we establish sound national guidelines on the use of active surveillance protocols quickly
- That we recognize the critically important role of the primary care community in diagnosis and prognosis of early stage prostate cancer and educate these physicians appropriately in the supervision of patients at risk (because well-established active surveillance protocols don’t need to be carried out by specialists in urology)