SAN FRANCISCO (KCBS RADIO) -- Prostate cancer is on the rise in California, with more men being diagnosed at advanced stages. A study from UCSF, led by researcher Erin Van Blarigan, suggests that this increase may be linked to lapses in routine screenings, which are crucial for detecting tumors early.
Looking at data from the National Cancer Institute's SEER program and the California Cancer Registry, UCSF researchers found that from 2011 to 2021, advanced prostate cancer diagnoses increased by 6.7% per year. But instead of suggesting improved detection, the increase indicates a more alarming trend, Van Blarigan told KCBS Radio's Bret Burkhart on this week's episode of "As Prescribed."
"For all cancers, we want to catch them early. That would be what we call localized or early stage, and those are more treatable. If you treat at the early stage, people have a better outcome," Van Blarigan said. "If they get to the advanced stage, which is really where we're seeing this rise in prostate cancer, those cancers are much harder to treat and can become fatal. Seeing a rise in specifically advanced stage is not a good thing."
The importance of early detection through screening cannot be overstated. However, prostate cancer is notoriously challenging to screen for.
"Prostate cancer is a complicated disease where it's very common, but most of the cancers and tumors that form in the prostate are not actually harmful to the person who has them. They don't progress. They don't leave the prostate, and in many cases, they don't need to be treated. They can just be watched and monitored," Van Blarigan said.
Unfortunately, there is a small subset of tumors — around 7% — that do advance, and these are the ones that need early detection and treatment. Yet, as Van Blarigan pointed out, there is no perfect screening method: "The screening test can't differentiate" between the harmless tumors and those that could become life-threatening.
Over time, the guidelines for screening have evolved. In 2012, the recommendation was made to stop routine screening due to concerns about over-diagnosis and the harm it caused. In 2018, the guidelines were updated again to suggest that men aged 55 to 69 discuss the pros and cons of screening with their doctor.
Despite these changes, "we're not sure how often those conversations are happening and if people are getting that... people who are high risk, maybe based on family history or race or age, are getting screened appropriately," Van Blarigan noted.
The primary issue with screening is the risk of false positives, where men are told they have cancer when they don't.
"If you have this indolent tumor that is never going to cause you any problems if you didn't know it was there. Certainly, getting told you have cancer, yes, causes anxiety and stress, but it also has an impact. Depending on what treatment decisions are made, the treatments for prostate cancer do have side effects," Van Blarigan explained.
While screening is essential, experts are still trying to figure out how to identify the dangerous tumors without raising unnecessary alarms for men who have tumors that don't require treatment. Advances in imaging and biomarkers are making progress in identifying aggressive forms of prostate cancer, but more work is needed to refine these tools.
"The goal is to be able to screen for prostate cancer, specifically identify when somebody has a bad form, catch it early, treat it, and hopefully cure that person," Van Blarigan said.
Achieving this goal requires continued investment in both medical research and cancer surveillance, which is essential for progress.
"Things are improving," Van Blarigan added, "and the guidelines will continue to improve taking information from our study and others so that we can have that more personalized and targeted approach to screening and treatment."
Listen to this week's "As Prescribed" to learn more. You can also listen to last week's episode to learn about what's driving a recent increase in throat cancer, here.
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“As Prescribed” is sponsored by UCSF.