Over 380,000 new cases a year in 2030?

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)

One Response

  1. Hi Dr. K.,

    Without a doubt statistics are tricky, accounting for why they have been dubbed “damn lies.” What makes the subject of how widespread prostate cancer is today even more complicated is the reality that what we know today about current incidence is based on National Cancer Institute (SEER) data that are generally 5 years old. Current statistics are in fact projections, subject to study assumptions, sampling errors, and time lags.

    I agree that prostate cancer can often be indolent and non-threatening, but scientists have an obligation to perfect tests to determine how aggressive men’s prostate cancers may become once they are screened and identified. It seems nobody knows, and this complicates matters, provoking needless anxiety for the majority whose tumors are currently not life-threatening.

    As you imply, the problem is that right now there’s no way to assure the 90% of men who are newly diagnosed with early-stage prostate cancer that they are NOT going to be among the minority whose tumors might in time take a turn for the worse. And that leads to widespread anxiety even among the majority who will never have to worry about mortality from the disease.

    The bigger worry for most of us prostate cancer survivors, regardless of the treatment we chose (be it active surveillance or more invasive approaches) is how much will our tumors affect our quality of life, leading to pain and stress for us and our wives or partners. Having had a radical prostatectomy myself, with no positive margins according to the my post-op biopsy, makes me feel relatively assured that I’m not likely to suffer a recurrence … but that is still a possibility, however remote.

    I’m dismayed that some leading scientists (including the chief medical officer of the American Cancer Society) dismiss routine cancer screening as unnecessary and wasteful — in terms of causing needless anxiety and spending billions of dollars in health care money that could be spent better elsewhere. Their argument is that most men won’t die of prostate cancer but WILL suffer from anxiety and the after-effects of treatment, more than they will from the prostate cancer itself.

    However, In my mind, more precise screening, rather than no routine screening until symptoms emerge, is needed to help us resolve human and fiscal concerns. Screening itself (PSA + biopsy) is not the problem as much as gaps of information about what’s really happening within our bodies and how quickly self-contained tumors might get out of hand.

    Besides, medical experts should realize that for many of us, our concern about how best to handle quality of life issues is perhaps even more important than how much longer we are going to live.

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