Prostate cancer cases will double by 2040, projection shows

The cases of prostate cancer are expected to double from 1.4 million per year in 2020 to 2.9 million per year by 2040, mainly in low- and middle-income countries. The prediction is from a study carried out by The Lancet Commissionwhich will be presented at the Congress of the European Association of Urology, which will take place from April 5th to 8th, in Paris, France.

The number of deaths per year caused by the tumor also expected to increase by 85% over 20 years , rising from 375,000 deaths in 2020 to almost 700,000 deaths by 2040, according to the study. The prediction is that the Most deaths occur in low- and middle-income countries , due to the increase in the number of cases and mortality rates that have already been recorded in these locations. Deaths from prostate cancer, on the other hand, have declined in most high-income countries since the 1990s.

In Brazil, the prostate cancer is the second most common among men , second only to non-melanoma skin cancer. A age is an important risk factor since the incidence is higher in people over 60 years of age . Family history of prostate cancer is also a risk factor, in addition to being overweight, obesity, smoking and exposure to chemicals such as aromatic amines, arsenic, petroleum products, vehicle exhaust, polycyclic aromatic hydrocarbons, soot and dioxins.

For the study authors, the population aging and increasing life expectancy cause the number of older men to grow over the years, increasing the risk for prostate cancer as age is one of the main factors associated with the development of the tumor.

“As more and more men around the world live into middle age and old age, there will be an inevitable increase in the number of prostate cancer cases. We know this increase in cases is coming, so we need to start planning and acting now. Evidence-based interventions, such as improved early detection and education programs, will help save lives and prevent health problems from prostate cancer for years to come. This is especially true for low- and middle-income countries, which will bear the majority of future cases,” says Nick James, lead author of The Lancet Commission and professor at the Institute of Cancer Research in London.

In conversation with the CNN Bruno Benigno, one of the heads of urology and oncology at Oswaldo Cruz Hospital, agrees with this view.

“It is necessary to take into account that the main risk factor [para o câncer de próstata] It is the age. We are seeing that, in developing countries, the population is aging. This is happening in Brazil, for example, as we already have more adults than young people. This means that, in the coming years, we will have a greater proportion of the Brazilian population in the age group over 60 years of age, which in itself is a greater risk factor for prostate cancer”, he comments.

Furthermore, the expert explains that the Modern lifestyle also represents a risk factor related to the development of cancer . “We still don’t have a direct correlation, but we know that diabetes and a sedentary lifestyle are associated with a greater susceptibility to developing cancer in general”, he adds.

Study shows disparity in early detection between low- and high-income countries

In high-income countries, especially, the main way to diagnose prostate cancer early is through PSA test , a blood test that measures levels of prostate-specific antigen, a type of protein. However, this exam often detects non-aggressive tumors that often may not require treatment, just “active surveillance ” — a strategy to monitor the patient to analyze whether the tumor is progressing or not.

The committee involved in the current study argues that there is evidence that, in developed countries, this approach leads to over-screening in older men at low risk for cancer, but does not increase early diagnosis in younger men at higher risk.

On the other hand, the study authors point out that, in low- and middle-income countries, most men are diagnosed with the tumor already in the metastatic stage — when the cancer spreads to other areas of the body. This shows that, In these places, tracking is still an important need .

“Here in Brazil, for example, if you fail to do this screening, patients who already have difficult access to the urologist will arrive at the office later and later, when the cancer is already advanced”, says Benigno. “So, in developing countries, it is still necessary to increase screening to reduce the rate of patients with metastatic cancer”, he adds.

Currently, there is discussion about the need for prostate cancer screening tests. For years, the Ministry of Health and Inca (National Cancer Institute) have not recommended population screening on the grounds that scientific studies have found that screening programs do not have a major impact on reducing mortality from the disease and can cause harm to the health of the population. man. On the other hand, medical societies, such as the Brazilian Society of Urology, advocate screening for the early detection of cancer.

“Investigation for early detection is essential to diagnose prostate cancer while it is still located only in the organ. The chances of a cure in these situations exceed 90%”, says André Berger, uro-oncologist and associate professor in the department of urology at University of Southern Californiain Los Angeles, at CNN .

Important strategies to minimize the impact of prostate cancer

For the authors of the study, there is the need to increase awareness about the risks and symptoms of metastatic prostate cancer among men and their families in low- and middle-income countries. From the researchers' point of view, public awareness about the main characteristics of advanced cancer is still low.

It is also necessary raise awareness about the importance of early diagnosis . “Diagnosing prostate cancer while localized exponentially increases the chances of a cure. Precision diagnosis greatly helps in personalizing treatment and defining the need and timing intervention”, says Berger.

For Benigno, it is also necessary expand prostate cancer screening in Brazil , to prevent the tumor from being diagnosed at an advanced stage, reducing the risk of mortality. Furthermore, it is important to spread the information that Not all prostate cancer needs treatment . “There are tumors that are not very aggressive, that only require active surveillance, and this strategy still needs to be disseminated,” he says.

The specialist also comments that, in the future, artificial intelligence could contribute to the identification of more aggressive and less aggressive tumors, helping to guide the best strategy for monitoring and treating cancer.

Finally, the study points to the need for greater infrastructure and specialized staff to carry out the diagnosis and adequate treatment of prostate cancer, with greater access to radiotherapy and surgery for patients from low- and middle-income countries.