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Why are late-stage prostate cancers on the rise?

Doctor consulting with patient

Prostate cancers aren’t being caught as early as they used to be. Here’s why — and how to protect yourself.

Hallie Levine

By Hallie Levine

The prostate can be troublesome for men over 50. The walnut-sized gland that wraps around your urethra tends to grow with age. And that can make urgent runs to the restroom more common.

For many men, this swelling is the worst that will happen to their prostate. It’s called benign prostatic hyperplasia (BPH). It can’t be cured, but it can be treated with surgery or medications such as tamsulosin (Flomax®). (Be sure to use the Optum Perks prescription discount card every time you pick up a medication at the pharmacy.)

For others, this have-to-go symptom can be a sign of something much more serious: a prostate tumor.

About 1 in 8 men will be diagnosed with prostate cancer during their lifetime, according to the American Cancer Society (ACS). It’s also the second-leading cause of death from cancer among American men.

The good news: Most men diagnosed with prostate cancer don’t die from it. But survival has a lot to do with when it’s caught. In fact, the number of men being diagnosed with “distant stage” prostate cancer is on the rise. That means the cancer has spread to other parts of the body. And it can make this common cancer more deadly.

We talked to experts about why they think distant stage cancer is increasing. Plus, we look at the new medications and up-and-coming technologies that could save your life.

Why advanced prostate cancer cases are rising

Well, it turns out that there’s no great way to detect it.

Many men choose a screening for prostate cancer called the prostate specific antigen (PSA) test. This blood test measures the PSA level in your blood. The theory: If you have prostate cancer, your prostate glands make more PSA. So if you have elevated PSA levels in your blood, it could be a sign of prostate cancer.

But the results aren’t always clear. PSA can be elevated for other reasons besides prostate cancer. According to the ACS, those reasons can include:

  • Having an enlarged prostate, or BPH
  • An infection or inflammation of the prostate gland
  • Recent sexual activity
  • Activities that put pressure on the prostate, such as bike riding or certain medical procedures
  • Taking medications that raise testosterone levels

In fact, only about 25% of men with high PSA levels have prostate cancer. That’s according to the National Cancer Institute.

The test caused many men to get biopsies they didn’t need. And it put them at unnecessary risk for infection and bleeding. That’s why the U.S. Preventive Services Task Force initially changed its recommendation on PSA tests. In 2012, it recommended that all men forgo PSA tests. But in 2018, the task force revised that decision. It now recommends that men ages 55 to 69 first weigh the pros and cons with their health care provider. The task force still recommends against PSA tests for men 70 and older.

The result of the task force’s advice? Men stopped getting screened at the rates they used to, explains Francisco Garcia-Moreno, MD. He’s the division chief of Oncology and Hematology at ProHEALTH and is based in New Hyde Park, New York. “On the one hand, we stopped picking up more benign forms of prostate cancer. And that’s a good thing, as it prevents overtreatment,” he says. “But on the other hand, we started to miss more aggressive cases that spread quickly.”

 

Could a new biopsy technique for prostate cancer help?

It definitely could. If doctors suspect you have prostate cancer, they typically do a transrectal ultrasound-guided biopsy. But this technique isn’t all that accurate. In fact, more than 30% of the time it can give false negatives (it says you don’t have prostate cancer when you do).

There’s a promising new biopsy tool on the horizon, though. It’s called the UroNav guided fusion biopsy system. It uses both MRI and 3D ultrasound images. This allows doctors to accurately locate the tumor and get a sample from the lesion itself. A study in The New England Journal of Medicine found that it missed only 3.5% of aggressive tumors. And that’s good compared with the nearly 17% missed with a traditional biopsy.

“It’s also less likely to cause an infection because we’re not going through as much skin,” explains Ardeshir Rastinehad, DO. He’s system director for prostate cancer at Northwell Health and vice chair of the urology department at Lenox Hill Hospital in New York City. “It also really allows us to focus on the suspicious area and leave the rest of the prostate untouched.”

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Are there effective treatments for prostate cancer?

Male hormones such as testosterone can fuel prostate cancer growth. So the first-line treatment for advanced prostate cancer is usually androgen deprivation therapy (ADT). It deprives the body of those specific hormones to starve cancer cells.

The most common ADT involves gonadotropin-releasing hormone (GnRH) agonists. They temporarily turn off the testicles’ production of male hormones. Examples include leuprolide (Lupron®) and goserelin (Zoladex®). One, called degarelix (Firmagon®), works more rapidly than the others. Lupron and Firmagon are given as an injection, and Zoladex is an implant. But relugolix (Orgovyx®) is available as a pill.

The downside to GnRH agonists is that male hormone production can increase at the start of treatment before it falls. So doctors can add a second medication to block that initial bump. It’s called an antiandrogen. Examples include flutamide (Eulexin®) and bicalutamide (Casodex®).

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There are also a few other exciting treatments available now, says Dr. Garcia-Moreno. Some new medications include:

  • Zytiga® (abiraterone). It decreases the effects of male hormones.
  • Xtandi® (enzalutamide), Erleada® (apalutamide) and Nubeqa® (darolutamide). These are all new medications approved by the U.S. Food and Drug Administration. They also decrease the effects of male hormones. And they’ve been shown to improve outcomes in those with prostate cancer that has spread.

As with all medications, it’s important to speak with your doctor about potential side effects. Hormone therapy for prostate cancer can cause a range of symptoms, including:

  • Lowered libido
  • Weight gain
  • Fatigue
  • Mood swings
  • Loss of muscle mass and physical strength

Medications aren’t the only budding treatment that can help. Immunotherapy is becoming more common. It uses the body’s immune system to help slow down cancer growth. It’s given either as an intramuscular injection or into a vein.

Choosing how and when to screen yourself for prostate cancer isn’t easy. Be sure to talk with your doctor about your risk factors and options. And if you’re diagnosed with prostate cancer, know that there’s hope. “There are so many promising therapies out there that I beg everyone not to give up,” says Dr. Garcia-Moreno. “We’re experiencing a quantum leap in treatments. We all must have hope for the future.”

 

Additional sources
Prostate cancer statistics: American Cancer Society
Factors that can raise PSA levels: American Cancer Society
Elevated PSA levels and prostate cancer: National Cancer Institute
Prostate cancer screening recommendations: U.S. Preventive Services Task Force
Study comparing biopsy techniques: The New England Journal of Medicine

 

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