The University of Aberdeen's Chair in Urological Surgery has contributed to new report which predicts cases of prostate cancer will double by 2040, with the highest increase in cases in low- and middle-income countries (LMICs).
The findings from The Lancet Commission on prostate cancer will be presented at the European Association of Urology Congress which takes place in Paris from 5 to 8 April.
The University’s Professor James N'Dow is one of four working group chairs for the Commission, chaired by Nick James from Institute of Cancer Research and Royal Marsden Hospital London.
Their research forecasts a projected rise from 1.4 million cases per year in 2020 to 2.9 million per year by 2040 and the number of annual prostate cancer deaths worldwide is predicted to rise by 85% over the 20-year period, from 375,000 deaths in 2020 to almost 700,000 deaths by 2040.
Most of these deaths are expected to be in LMICs, due to the rising number of cases and increasing mortality rates in these countries. Deaths from prostate cancer have declined in most high-income countries (HICs) since the mid-1990s.
Prostate cancer is already a major cause of death and disability, accounting for 15% of all male cancers. It is the second most common cause of cancer deaths in UK men and the most common form of male cancer in more than half of the world’s countries.
In LMICs there is an urgent need for cancer screening trials and new approaches to enable earlier diagnosis, as most men in these countries present with metastatic cancer – an advanced form of disease where the cancer has spread to other parts of the body, often the bones. Men with late-stage prostate cancer are much less likely to survive for a long period of time than those who are diagnosed early.
Professor N’Dow’s own work also focuses on the need to raise awareness of the dangers and symptoms of late diagnosis of prostate cancer among men and their families including in LMICs, where understanding of the scale, impact and management of advanced prostate cancer – such as bone pain, caused by metastatic disease – is poor.
Improving education about the disease is critical and the Commission authors suggest that programmes should involve new technologies and channels such as smartphones, social media and influencers. They highlight Project PINK BLUE, an organisation that delivers a range of programmes to raise awareness of breast, cervical and prostate cancer in Nigeria and provides free cancer screening. Many of Project PINK BLUE’s programmes utilise digital technologies and involve well-known public figures and celebrities.
Professor N’Dow, who is also the Founder of Horizons Trust & Horizons Clinic, Gambia, which aims to improve access to healthcare and promote community outreach and education, said: “The issue in low- and middle-income countries is that late diagnosis of prostate cancer is the norm. Improved outreach programmes are needed to better inform people of the key signs to look out for and what to do next. Implementing these in tandem with investments in cost-effective early diagnostic systems will be key to preventing deaths from prostate cancer as cases inevitably rise with a global ageing population.”
He continues, “As well as the obvious direct effects on individual men’s health, rising numbers of cases and deaths from prostate cancer could have huge economic and social impacts on families in LMICs. Men in these countries are very often a family’s main breadwinner, so if they die or become seriously ill, this can lead to families facing major economic hardship. By preparing now for the upcoming surge in prostate cancer cases, with a particular emphasis on improved education and earlier diagnosis programmes, many of these harms could be reduced substantially.”
Expanding early diagnostic capabilities in LMICs will increase the rates of detection of early-stage prostate cancer, further increasing demand for surgery and radiotherapy. Urgent measures are therefore needed to build surgical and radiotherapy capacity in these countries. The Commission authors state that establishing regional hubs could provide the infrastructure needed to increase specialist training and improve patient access to radiotherapy and surgery.
For men with metastatic disease, earlier diagnosis and starting hormone therapy earlier will reduce deaths and prevent serious complications like painful spinal cord compression and urinary retention, which can lead to infection and kidney damage.
The Commission authors also highlight the need for more research to better understand prostate cancer in men who are not of White European origin, to enable improved detection and care in these groups. Research and knowledge of prostate cancer is heavily focussed on White European men, and most studies have been done in HICs. However, Black men, especially those of West African descent, have a higher risk of developing prostate cancer than White or Asian men, though the reasons for this are unclear. There is also a higher death rate from prostate cancer among Black men, but it is not known if this is driven by the differences in case rates or by other factors such as differing disease biology or societal factors such as deprivation or racism. More data is needed to identify the driving factors behind these trends.
The Commission authors call for mandatory recording of ethnicity in clinical trials, and that trials should reflect the ethnic mix of the populations being studied to ensure that the findings apply to all groups. The Commission authors also call for trials examining prostate cancer screening, early diagnosis, and treatment in LMICs.
The report can be found here.