Prostate cancer shouldn't be a death sentence. But for a startling number of U.S. males, it is

Since 2014, U.S. diagnoses of prostate cancer—highly survivable if caught early—have risen 3% annually. Advanced-stage diagnoses have risen 5% year over year.

Adding insult to injury, Black men are being diagnosed with late stages of the condition at two to three times the rate of white men, and are also around 2.5 times more likely to die of it, experts say.

It’s a reality that has experts like American Cancer Society CEO Karen Knudsen “ringing the alarm bell across the country.”

The deaths and disparities are tragic enough. What’s even more tragic: that tens of thousands of U.S. men die each year of a condition that, when detected early, has nearly a 100% survival rate. One major driver, according to experts: confusion surrounding screening guidelines issued by a medical task force in 2012—despite the fact that the controversial recommendations were revised several years later. 

As Knudsen points out, “The second leading cause of cancer death for men is a very survivable cancer.”

U.S. prostate cancer statistics are “telling us something,” she says: “We’re not finding it early enough.”

It’s a topic that’s made headlines again as of late, after a Feb. 5 announcement that King Charles III is being treated for an unspecified form of cancer detected during treatment for a benign prostate condition.

The reason behind the rise

In the early 1990s, the U.S. Food and Drug Administration approved a test called the PSA—or prostate-specific antigen—for early detection of prostate cancer. The simple blood draw detects a protein produced by cells in the prostate gland, with a rise often signaling prostate cancer. After the approval, prostate cancer diagnosis rates began to rise swiftly.

PSA levels, however, aren’t just elevated by prostate cancer. Benign factors like infection or stimulation from riding a bike or vigorous sexual activity can also cause a rise, according to Dr. Bilal Siddiqui, an oncologist with the MD Anderson Cancer Center at the University of Texas.

Inevitably, artificially elevated PSA levels resulted in unnecessary biopsies—and, along with them, undesirable side effects like incontinence, anxiety, and erectile dysfunction in some. Concerned that the blood test was doing more harm than good, in 2012, the U.S. Preventive Services Taskforce changed its guidelines to recommend against the use of it for prostate cancer screening.

Two years later, prostate cancer diagnosis rates began a steady ascent.

“Sometimes when you throw the baby out with the bathwater, you have unintended consequences,” Dr. William Oh—an oncologist and professor at the Icahn School of Medicine at Mount Sinai in New York, and chief medical officer of the Prostate Cancer Foundation—tells Fortune.

The 2012 recommendation—or reverse recommendation, of sorts—“created confusion in the minds of men, but also primary care providers,” Knudsen says. While the task force updated its recommendation again in 2018—to state that men between the ages of 55 and 69 should discuss screening with their doctor, weighing the risk and benefits—the damage, apparently, was done.

More than a decade after the initial recommendation, advances in imaging have reduced unnecessary biopsies, Knudsen says. And prostate cancer screening is safe and easy, with “no inherent harm.”

Anymore, there’s no reason not to initiate a conversation about it with one’s doctor, she adds—especially for men 50 and older, and those with a family history of prostate cancer or known genetic risk.

“No one should wait to get a prostate screening until they are symptomatic,” she says. “It’s simple and a platform for an important discussion with one’s physician.”

‘Watchful waiting’ an option for many patients

Not all prostate cancers are the same, experts say—and that’s good news for a good deal of men with the condition. Many prostate cancer patients have “relatively low grade disease” that hasn’t spread beyond the prostate itself, and treatment may simply involve “watchful waiting,” Knudsen says.

Men who catch their prostate cancer early are unlikely to die from it, statistics show. In fact, studies have found that up to 50% of men autopsied died with prostate cancer, but not from the condition—signaling that, “to a certain extent,” some cellular changes along the spectrum of prostate cancer “may indeed be a normal part of the aging process,” Siddiqui says.

“There are prostate cancers that will never be lethal in a man’s lifetime,” Oh advises. “As you get older, some men—many men—will have small amounts of prostate cancer in their prostate. The goal with those men is not to treat them if they don’t need treatment. It’s very important to separate these men and do active surveillance.”

Such patients stand in contrast to men with a family history of the disease and/or those who have genetic risk factors, who often face more aggressive disease. While famous for fueling breast and ovarian cancers thanks to the advocacy of movie star Angelina Jolie, harmful mutations on the genes BRCA1 and BRCA2 can also confer a higher risk of prostate cancer, experts say. Those with such mutations on BRCA1 have an estimated 30% risk of developing prostate cancer during their lifetimes, according to a 2022 article in the Journal of the National Cancer Institute. That risk rises to 60% among carriers of BRCA2 mutations.

Options for treating high-risk, predisposed patients include radiation and surgery—and such patients must be treated “as aggressively as possible,” Oh says.

People tend to think of prostate cancer as one condition, and it’s simply not true, Oh contends. As Knudsen says, cancer as a whole is more than 200 different diseases, and even prostate cancer cases can be divided into groups, or categorized on a spectrum.

A young patient with an “aggressive-looking” prostate cancer, whose father had the condition and who carries a BRCA2 mutation, is an entirely different patient from “an 80-year-old man who happens to have a biopsy and shows a very low grade, slow-growing” prostate cancer,” Oh advises.

“Those two men couldn’t be more different,” and their treatment should be vastly different too, he adds. 

What to look for, and when to act

Symptoms of prostate cancer can vary widely, and some patients don’t show symptoms at all, according to the U.S. Centers for Disease Control and Prevention. The following symptoms, however, may be telltale signs:

• Difficulty beginning to urinate
• Weak urine flow, or interrupted flow
• Frequent urination
• Trouble fully emptying bladder
• Pain or burning while urinating
• Blood or semen in urine
• Back, hip, and/or pelvis pain that doesn’t go away
• Painful ejaculation

Patients diagnosed in early stages of the condition can have a “high expectation of cure,” Knudsen says, and “can continue to have a wonderful quality of life.” In fact, the five-year survival rate for prostate cancer detected early is virtually 100%, Siddiqui says.

The outlook for late-diagnosed patients, however, is not nearly as rosy. There is no “durable cure” for such cancer, Knudsen points out. The five-year survival rate for advanced prostate cancer is only 31%, according to Siddiqui.

When it comes to prostate cancer prevention, “what’s good for your heart is good for your prostate,” Oh advises. He encourages men to pack their diets full of leafy green veggies and colorful fruits, and to limit dairy and barbecued meat, which are associated with a higher risk of prostate cancer and aggressive prostate cancer.

“Exercise is also associated with a favorable outcome,” he adds.

And when it comes to detection? Once men are in their 40s—or earlier if they’re Black, have a family history of cancer, or carry a genetic mutation associated with prostate cancer—Oh recommends they talk to their primary care provider or urologist about screening. The conversation should occur every year or two.

“Doctors are very busy and have different feelings about everything, actually—especially in the area of cancer screening,” he says. “Unfortunately, cancer screening is more controversial than it should be. Guidelines change quite often, and differ from one organization to another. It makes it harder for the average person to know what to do.”

If you don’t feel heard when talking to your doctor, get a second opinion, he recommends.

Adds Oh: “Early detection of a bad disease is always better.”