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Countries should overhaul testing for prostate cancer to focus more on vulnerable groups, scientists have urged, as new research forecasts global deaths from the disease will almost double in 20 years.
Low- and middle-income countries need to prepare to prevent a sharp rise in fatalities while richer nations should pay more attention to young men at higher risk of the disease, according to research published on Thursday.
The paper by the Lancet Commission highlights the urgency of reviewing diagnostic practices as a jump in prostate cancer cases is driven by rising life expectancy around the world.
“We’re going to see big case increases in high-income countries and even bigger increases in low- and middle- income countries, which are baked in because of an ageing population,” said Nick James, the commission’s lead author and a professor at the UK Institute of Cancer Research.
“The only thing you can do to mitigate the damage that will cause is to set up programmes that diagnose it earlier to allow earlier treatment.”
Annual deaths from prostate cancer will reach almost 700,000 by 2040, a rise of 85 per cent from 2020, the commission estimated. Case numbers will more than double to 2.9mn over the same timeframe.
Regions in Africa and the Caribbean had the highest rates of prostate cancer mortality in 2020, with countries such as Zimbabwe, Barbados and Ivory Coast among the worst affected. This reflects both late diagnosis and the higher risk that Black men appear to have of developing the disease, for reasons that are still not well understood.
Prostate cancer accounts for almost one-sixth of male cancers, making it the most common form of the disease in more than half the world’s nations. Deaths from the condition have fallen in most high-income states over the past 30 years, partly reflecting public health campaigns and increased testing.
Low- and middle-income countries will need to be prepared for the strain the expected surge in cases will put on health resources, according to the research. Measures could include expansions of already developing diagnostic trends, such as having nurses conduct tests and using artificial intelligence techniques to help analyse pathology results.
“Improved outreach programmes are needed to better inform people of the key signs to look out for and what to do next,” said Professor James N’Dow, a commission member and founder of Horizons Trust & Horizons Clinic in The Gambia. “Implementing these in tandem with investments in cost-effective early diagnostic systems will be key to preventing deaths.”
High-income countries should re-evaluate the use of “informed choice” on-request blood protein testing for older men, the report said. The technique — known as prostate-specific antigen testing — has drawbacks such as flagging cancers that may never cause symptoms and need no treatment.
“Research shows that the PSA test, when used for screening in men with no symptoms, is inaccurate,” said Naser Turabi, director of evidence and implementation at the charity Cancer Research UK, who was not involved in the Lancet Commission research. “It can result in the overdiagnosis of low-risk prostate cancers while also missing some high-risk cancers.”
Richer nations should spend more on public awareness campaigns and MRI scans for younger men who are at higher risk, said the commission. These would include people who have a family history of the disease, are of African ancestry or carry a genetic mutation known as BRACA2.
More research is needed among various ethnic groups to expand understanding of prostate cancer beyond the findings from studies that were largely based on data from white men, the commission added.
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