Prostate cancer cases are expected to double between 2020 and 2040, as populations age and life expectancy increases worldwide, a study found.
Annual cases are projected to reach 2.9 million in 2040, up from 1.4 million in 2020, with deaths rising by 85 per cent over the period to almost 700,000 each year.
Low and middle-income countries are expected to experience the highest increase in cases and deaths, due to rising mortality rates compared with most high-income countries, where deaths from the disease have fallen since the mid-1990s.
And because the main risks for the cancer – ageing and a family history of the disease – are unavoidable, researchers warn it will not be possible to avoid the coming surge.
“As more and more men around the world live to middle and old age, there will be an inevitable rise in the number of prostate cancer cases,” said Prof Nick James, lead author of the study, who specialises in prostate and bladder cancer research at the Institute of Cancer Research, London.
“We know this surge in cases is coming, so we need to start planning and take action now.
"Evidence-based interventions, such as improved early detection and education programmes, will help to save lives and prevent ill health from prostate cancer in the years to come. This is especially true for low- and middle-income countries, which will bear the overwhelming brunt of future cases.”
The research was carried out by the Lancet Commission on prostate cancer and will be launched by a presentation at the European Association of Urology Congress, which runs from April 5 to 8.
Prostate cancer is the second most commonly diagnosed cancer in men. According to the NHS, symptoms do not usually appear until the prostate is large enough to affect the tube that carries urine from the bladder. They include an increased need to urinate, straining when passing urine and a feeling that your bladder has not been fully emptied.
However, symptoms of an enlarged prostate do not necessarily mean cancer is present.
Screening for the condition is commonly done by a PSA test, a blood test that measures levels of a protein called prostate-specific antigen (PSA). However, the test often detects prostate cancer that may never cause symptoms and does not need treatment.
There is currently no screening programme for prostate cancer in the UK because the NHS says the benefits have not been proven and the PSA test is often unreliable.
Screening instead relies on "informed choice" PSA testing, which means it is only carried out following a discussion of risks and benefits with a doctor.
The study authors recommend the use of MRI scans in combination with PSA testing to screen men at high risk of the disease, such as those who are of African origin, carry a BRACA2 mutation or have a family history of the cancer in high-income countries.
They say the approach would detect potentially deadly disease while reducing over-diagnosis and over-treatment. However, they caution that MRI scans should not be used alone, since biopsies are the most effective way of identifying aggressive cancers.
The commission said more research was needed into prostate cancer in non-white European men to improve detection and treatment.
Research tends to focus on white European men, despite the risk being higher for black men, particularly those of west African descent. Statistics show they also suffer a higher death rate.
The researchers said cancer screening trials were needed urgently in low and middle-income countries to enable earlier diagnosis, because most men there present with an advanced form.
Low and middle-income countries also require more awareness about the symptoms of metastatic cancer, which can include bone pain, caused by metastatic disease.
The authors suggest that programmes should involve new technology and channels including smartphones, social media and influencers.
“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 low-and middle-income countries," said Prof James N’Dow, chairman in surgery at the University of Aberdeen and founder of Horizons Trust and Horizons Clinic in Gambia.
“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.”
The NHS through the decades - in pictures
