Global Prostate Cancer Crisis

GS Paper I

News Excerpt:

A report on prostate cancer by the Lancet Commission has unveiled a looming global crisis in the fight against the disease.

Key findings of the report:

  • According to the commission’s findings, cases of prostate cancer are set to double from 1.4 million annually in 2020 to a staggering 2.9 million per year by 2040.
  • This alarming revelation was disclosed during a recent presentation at the European Association of Urology Congress. 
    • More concerning is the projection that it will be the low- and middle-income countries (LMICs) that will see the surge in these cases.
  • In another worrying prediction, the Commission estimates an 85% increase in annual deaths worldwide over the same 20-year period, soaring from 375,000 deaths in 2020 to nearly 700,000 deaths by 2040. 
    • It’s feared that the actual numbers may be even higher due to under-diagnosis and insufficient data collection in LMICs. 
    • The burden of these fatalities is expected to weigh heavily on LMICs, where both the number of cases and mortality rates are on the rise.
  • In stark contrast, deaths from prostate cancer have seen a decline in most high-income countries (HICs) since the mid-1990s.
  • Prostate cancer is a significant contributor to mortality and disability, accounting for 15% of all male cancers globally. 
    • In the United Kingdom, it ranks as the second most common cause of cancer deaths among men, while in more than half of the world’s countries, it stands as the most prevalent form of male cancer.
  • Adding to the complexity of the situation is the unavoidable nature of the main risk factors for prostate cancer, including age (50 and older) and family history. 
    • With ageing population and increasing life expectancy, the number of older men is set to rise in the years ahead. 
    • Unfortunately, lifestyle changes or public health interventions alone will not be sufficient to stem the tide of this impending surge in cases.

About Prostate Cancer: 

  • Prostate Cancer and most other cancers can be called a lifestyle disease. 
  • There have been some percentage of hereditary cancers, but largely cancers happen sporadically and contributed by some environmental factors as well.  
  • It is common for elderly men to have Lower Urinary Tract Symptoms (LUTS) which includes urgency, frequency of micturition, difficulty in passing urine and incomplete bladder evacuation. 
  • These symptoms require testing for enlarged prostate which mostly is non-cancerous (Benign Prostatic Hypertrophy or BPH). 

Causes of Prostate Cancer

Prostate cancer is a multifaceted disease influenced by a complex interplay of genetic, environmental, and lifestyle factors.

  • Genetic Factors:
    • Family History: Men with a first-degree relative (father or brother) diagnosed with prostate cancer are at a higher risk. The risk increases with the number of affected relatives.
    • Genetic Mutations: Certain inherited gene mutations, such as BRCA1 and BRCA2, which are linked to breast Cancer and ovarian cancers, also increase the risk of prostate cancer in men.
    • Race and Ethnicity: Prostate cancer is more prevalent in African-American men and less common in Asian and Hispanic men. The reasons for these racial disparities are not entirely clear but are thought to involve both genetic and environmental factors.
  • Age and Hormonal Factors:
    • Age: Prostate cancer is primarily a disease of aging. The risk increases significantly after the age of 50 and continues to rise with age.
    • Hormonal Imbalances: Testosterone, the male sex hormone, may promote the growth of prostate cancer cells. Hormone therapies that decrease testosterone levels are used in treating advanced prostate cancer.
  • Environmental Factors:
    • Diet: Diets high in red meat and high-fat dairy products and low in fruits and vegetables have been associated with an increased risk of prostate cancer. Conversely, diets rich in fruits, vegetables, and certain nutrients like lycopene (found in tomatoes) may lower the risk.
    • Lifestyle Choices: Sedentary lifestyles and obesity are linked to an increased risk of prostate cancer. Regular physical activity and maintaining a healthy weight can mitigate this risk.
    • Exposure to Chemicals: Prolonged exposure to certain chemicals like cadmium, a heavy metal, and agent orange, a herbicide used during the Vietnam War, has been linked to an elevated risk.
  • Medical Factors:
    • Inflammation: Chronic inflammation of the prostate, often seen in conditions like prostatitis, might increase the risk of developing prostate cancer.
    • Sexually Transmitted Infections: Some studies suggest a potential link between certain sexually transmitted infections, such as gonorrhea and chlamydia, and an increased risk of prostate cancer.
    • Medications and Supplements: The use of certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) and certain supplements, is being studied for their potential effects on prostate cancer risk.

Need for quick action:

  • Quick action is needed to make sure people in low- and middle-income countries are aware of prostate cancer and can get checked and treated early on. 
    • Right now, many men in these countries only find out they have prostate cancer when it’s already at an advanced stage.
  • According to the Commission, it is time that new tools like smartphones, social media, and influencers are used to disseminate information on the same. 
    • For example, a group called Project PINK BLUE in Nigeria does this kind of work. 
      • They offer free screenings for breast, cervical, and prostate cancer and use things like apps and also influential people to spread the word.

How Is Prostate Cancer Treated?

Different types of treatment are available for prostate cancer. which are-

  • Expectant management: If a doctor thinks prostate cancer is unlikely to grow quickly, he or she may recommend that not to treat the cancer right away. Instead, can choose to wait and see if you get symptoms in one of two ways:
    • Active surveillance: Closely monitoring the prostate cancer by performing prostate specific antigen (PSA) tests and prostate biopsies regularly, and treating the cancer only if it grows or causes symptoms.
    • Watchful waiting: No tests are done. a doctor can treat any symptoms when they develop. This is usually recommended for men who are expected to live for 10 more years or less.
  • Surgery. A prostatectomy is an operation where doctors remove the prostate. Radical prostatectomy removes the prostate as well as the seminal vesicles (glands that produce the fluids that will turn into semen).
  • Radiation therapy. Using high-energy rays (similar to X-rays) to kill the cancer. There are two types of radiation therapy—
    • External radiation therapy: A machine outside the body directs radiation at the cancer cells.
    • Internal radiation therapy (brachytherapy): Radioactive seeds or pellets are surgically placed into or near the cancer to destroy the cancer cells.

Building a strong system to fight Prostate Cancer (Way Forward)

  • In low- and middle-income countries, there aren’t enough trained doctors or specialized hospitals to provide efficient care for prostate cancer patients. 
    • A study in 2015 found that 9 out of 10 people in LMICs can’t get basic surgery when they need it. 
    • To help more people find out if they have prostate cancer, there needs to be a better way to diagnose it in LMICs. It's important to improve hospitals and train more specialists in these countries.
  • For men whose cancer has spread, finding it sooner and starting treatment earlier can save lives and stop bad problems like back pain or trouble peeing, which can lead to infections and kidney damage.
  • There is a need to do more research to understand prostate cancer in men who aren’t White European. 
    • Right now, most of what we know about prostate cancer comes from studies done on White European men in rich countries. 
    • But Black men, especially those from West Africa, are more likely to get prostate cancer than White or Asian men, and it isn’t known exactly why. So, more information is needed to figure out what’s causing these differences.
  • As the Lancet Commission sounds the alarm on the escalating crisis of prostate cancer, urgent global action is imperative to address the growing burden of this disease and prevent countless lives from being lost to its devastating effects.

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