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By:
Thomas A. Farrington
PHEN President and Founder
My prayers go out to former President Joe Biden as he battles prostate cancer. It is truly unfortunate that he was diagnosed with an aggressive, metastatic form of cancer. However, more men are being diagnosed with advanced prostate cancer today because, like President Biden, they are delaying early detection screening and only being tested when symptoms appear. The problem is that this stage of prostate cancer is incurable. I have seen too many men battle advanced prostate cancer to an ugly and tragic death.
President Biden and countless other men are victims of a fractured system for the early detection of prostate cancer. The PSA (prostate-specific antigen) test was introduced as the primary screening test beginning in the 1990s, and prostate cancer incidence and death rates subsequently declined by nearly 40% (2000 - 2012). All of this changed in 2012 when the United States Preventive Services Task Force (USPSTF) released a "D" recommendation that primary care doctors should not provide the PSA test unless patients presented with symptoms of prostate cancer. This was based on a flawed clinical trial that showed no survival benefit for patients who had received the PSA test. Now prostate cancer incidence and deaths are on the rise. In 2018, the USPSTF relented in the face of facts and provided a "C" recommendation that a patient and his doctor should discuss the benefits and risks of having a PSA test before the patient received the test. However, this has not changed the practice of many primary care doctors who do not discuss prostate cancer or the PSA test with their patients. Prior to 2012 Primary care doctors had historically provided the first line of defense against prostate cancer through early detection screening, but not anymore which leaves a critical void.
For 2025, prostate cancer incidence is estimated by the American Cancer Society (ACS) to be 314,000 cases, which is an 80% increase over its estimate of 175,000 cases in 2019. However, the 2019 actual incidence was 225,000 (the most current CDC data available). It should be noted that the estimated increase for this same period for breast cancer is 18% and for colon and rectal cancer is 6%, while lung and bronchus cancer cases decline. Considering that the ACS under-estimated its 2019 estimate by 50,000, continuing this trend would make prostate cancer the leading cause of major cancer in the United States today. Also, while we often hear that “prostate cancer is a slow-growing disease that you probably won't die from,” 35,000 men are projected to die from the disease in 2025, which is the second leading cause of cancer deaths for men behind lung cancer.
The facts are that we have an escalating prostate cancer crisis in this country without any national leadership recognizing it or steering this broken ship to a safe harbor. President Biden's metastatic diagnosis is symptomatic and not an aberration of this crisis. The USPSTF's current recommendation is the most significant obstacle to adequately addressing this crisis. Even President Biden's "Moonshot Initiative," which he championed as his signature effort on cancer prevention and early detection screening, did not include prostate cancer. The USPSTF, an entity of the Department of Health and Human Services, is an independent panel of experts in primary care and prevention that develops recommendations for clinical preventive services.
The current USPSTF recommendation has a narrow window of just 14 years (ages 55 to 69) when men should consider early detection screening. It makes no provision for men at high risk for prostate cancer (men with a family history, Black /African Americans, and those with certain genetic mutations). This screening window appears to be highly insufficient when compared to the National Comprehensive Cancer Network's (NCCN) prostate cancer guidelines' window of 35 years (ages 40 to 75). The NCCN panel is made up of medical specialists who treat and study men with prostate cancer.
We must wage an all-out war against prostate cancer to end this crisis of unnecessary deaths and suffering! The good news is that we are in a position to do just that. During the last decade, over-treatment of prostate cancer has been reduced steadily through active surveillance of low-risk disease; imaging is being used broadly to reduce unnecessary biopsies and over-diagnosis; and pharmaceutical organizations have provided a plethora of new and improved treatments, diagnostics, and biomarkers. All of these were areas of need cited by the USPSTF with its 2012 recommendation against PSA screening.
PHEN was a lead advocacy organization in efforts to have the USPSTF upgrade its screening recommendation in 2018. Today, we are calling on the USPSTF to revisit its current recommendation and upgrade it to the same level that it has for breast cancer, a "B" recommendation. We are asking that other advocacy organizations, medical leaders, community leaders, prostate cancer survivors and others join with us. This upgrade will re-engage primary care providers in the fight against prostate cancer as a first line of defense for early detection screening, and heighten overall visibility and support toward eliminating the prostate cancer crisis in the United States.
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