Although a recommendation against prostate-specific antigen (PSA) testing in men was made back in 2012, this move does not mean that our men are in the clear, particularly considering the numbers for survival rates of Black men in relation to advanced prostate cancer diagnoses.
Advanced prostate cancer cases appear to be on the rise, although government reports have shown an overall decline in prostate cancers over the past two decades.
According to Dr. Anthony D’Amico, Professor of Radiology Oncology at Harvard Medical School, the spike in advanced prostate cancers are a consequence of going against prostate cancer screening with PSA testing for men.
In 2012, the United States (U.S.) Preventative Task Force recommended an end to PSA screening due to the possible side effects and false-positive test results, which lead to unnecessary tests and prostate biopsies.
The effects of the prostate biopsies include bleeding, pain, and serious infections. In addition, men with elevated PSA levels end up not having prostate cancer after all, with only about 25% having prostate cancer once the biopsy is done.
The expectation for such a recommendation against PSA testing meant that cancer death rates would increase, as well as cancer that has spread (metastases, also known as Stage 4 cancer).
What occurs is the spread of cancer from the prostate to distant parts of the body, and it may take years after the initial diagnosis or after the cancer has initially been treated or removed.
D’Amico noted, upon the 2012 recommendation, that around 2015 to 2016, the increased instances of distant metastases would be more evident; around 2018 to 2019, cancer death rates would begin to increase.
In fact, reports show that the numbers doubled between 2003 and 2017 for cancer spreading to distant parts of the body, going from 4% to 8% according to the U.S. Center for Disease Control (CDC) and Prevention.
Men are dying because of increased metastatic disease and Stage 4 cancer, with obvious racial differences being reported by the CDC.
According to researchers, five-year survival for distant state prostate cancers were higher among Asian/Pacific Islanders (42%), followed by Hispanics (37%), American Indian/Alaska Natives (32%), Black men (32%), and white men (29%).
Being aware of and understanding these numbers, as well as staying atop of the continued research helps educate men about prostate cancer, which can lead to more talks between the patient and provider about the decision to utilize prostate cancer screening.
The key is about being smarter and knowing who to treat and who not to treat. Men with low-risk cases may not require PSA screening as an option, but the open discussion with a trusted and knowledgeable medical provider will help them in their decision-making.
The reversal of the PA screening recommendation did not occur until 2018, so it will take a couple of years before the plateau and decrease in Stage 4 cases will be noticeable.
Further knowledge of these cancer rates will greatly help with guiding treatment and managing the planning of survival care. Staying informed and educated is key.