Author: Geoff McLennan, prostate cancer patient and advocate

Every January since 1951 the American Cancer Society (ACS) has published an annual report about the frequency of most cancers. The 2023 report begins with sobering statistics: “Cancer continues to be the second most common cause of death in the US, after heart disease. In the US in 2023, a total of 1.9 million new cancer cases (about 5,370 cases each day) and 609,820 deaths from cancer are expected to occur (about 1,670 deaths a day).”

Most scientists, researchers and cancer advocates herald this annual report for its quality and well-vetted data from government institutions such as the National Institutes of Health (NIH). A notable fact reported by the 2023 ACS statistical report is that prostate cancer (PCa) is on the rise again, by 3% annually since 2018, whereas for the prior 20 years PCa had declined. Prostate cancer is the second leading cause of cancer death for men in the United States. These facts from the ACS deserve our attention.

Why are prostate cancer rates increasing?

In 2008 a federal taskforce called the US Preventive Services Task Force (USPSTF) reviewed the use of PSA testing (see my earlier blog post for the pros and cons of this test) and recommended that fewer men get tested because of diagnosis and overtreatment – that is, PSA testing had been shown to generate too many treatments of men who had a low grade PCa, resulting in comorbidities and mental health declines for both husband and their partners.

Shortly after that recommendation in 2018, urologists noted that men who were not PSA-tested were being diagnosed with higher-grade PCa’s that may be more difficult to treat, with severe consequences to the man and his family during treatments. Some cancer experts asserted that the taskforce deterred men from PSA testing, resulting in worse cancer when detected later. These findings have been exacerbated by the COVID-19 pandemic, when men were not getting healthcare regularly due to restricted access to clinics. However, for most men diagnosed with PCa, the result is a slow-growing cancer that will not cause early death. In fact, the five- and ten-year survival rates for all PCa is 98%. Only 2% will die during those time periods.

What should you do to avoid a serious case of prostate cancer?

Hopefully the current news and timing will work to your benefit. Based on the ACS report and the research that supports it, there are clearer choices for you. The ACS and other cancer experts recommend testing at an earlier age based on family and genetic testing (GT) results that indicate risk-based findings. A broader range of tests are available, including many offered by Myriad. The recommended age-based testing is according to ACS:

• At age 45 for men of African American ancestry. Black men in the US have a 73% higher risk of PCa than men around the globe.
• At age 50 for men who are at average risk

Other recommended factors to aid your care choices include:

• A clear knowledge of family cancers or genetic testing results from tests such as Myriad MyRisk® Hereditary Cancer testing that show inherited gene mutations such as  BRCA 1 or 2 and other genetic variants that may have caused your cancer.
• Other unique health circumstances that your doctor may identify as a reason for testing.

Be proactive in your healthcare. Regardless of the predictions, a key ingredient is to be informed, use that information to your health advantage and ask for help in understanding your prognosis. If you appear to fit into one of the testing categories above and have not been tested, make plans to see your primary care doctor and ask for a urology or genetic referral. Here again, the key to understanding your risks with PCa is a good relationship and clear communication with your primary care doctor and urology specialist.

How will these predictions affect me? Should I tell other men in the family?

If you are younger than forty you are unlikely to need testing. But it is a good time to become educated about PCa in your family. If you have PCa and have younger male siblings approaching forty years of age anywhere in the family tree, then consider informing those men about PCa. It could be a phrase as simple as, “I have PCa and understand it often runs in the family. You should let your primary care doctor know to include this information in your permanent medical record.”

It is also a good idea to tell men in your family to ask their doctors for a genetic test for cancer. Myriad offers the MyRisk Hereditary Cancer panel to screen for germline cancers. Germline means something carried by each set of parents in the family tree that bore children. Consider sharing quality health information with family men about your PCa story. This may require discerning action within your family, as some people are uneasy or do not share health status for many reasons, such as a preference for privacy. Privacy is understandable, but you can still reach family men and women with children and of childbearing age with your story. Be open and factual and remind everyone that they can always contact you again. Likewise, you can update family as you age with your PCa, and if your status changes or remains the same. Remind family to visit informative websites such as Myriad Cancer Care.

Ask the critical question, “Am I getting top-notch healthcare? If not, what action should I take?” Seek knowledge about PCa from a trusted patient advocacy organization such as Active Surveillance Patients International at ASPI. Be thankful for your days. Until the next post, we will continue to share quality information to help you grow more confident and feel less fearful. In a future post I will interview a Myriad geneticist about how genetic testing may be the future of PCa. Thank you for reading this post (and forget the earlier Casanova reference, as he’s not exactly a good role model!).

Are you newly diagnosed with prostate cancer?

Contact us at [email protected] or 513-216-4752 with any questions.

Author Bio

Geoffrey T. McLennan, MPA

Geoff is dedicated to helping families and friends support a prostate cancer patient. He joined the board of Active Surveillance Patients International (ASPI) in 2018 and is an 11-year PCa patient. As a PCa patient advocate, he envisions providing a broad understanding of how patients can collaborate with clinicians for realistic medical care. He enjoys meeting and learning from his clinicians, cancer researchers, providing free online programs for patients, and reminds us that “to live, learn and thrive with PCa” is the motto of ASPI. He is glad he took science courses for understanding a healthy lifestyle that includes exercise and diet.

Geoff also volunteers as a board member and past chairman of the Placer County Mental Health Advisory Board where his interest includes therapy and resources for AS men, and a broad oversight of community mental health programs and innovations. He is married to Constance McLennan, a fine artist, has a grown son, and lives in Northern California.