Why Are So Many More Men Getting Advanced Prostate Cancer? The New, Troubling California Data & Practical Guidance On Screening

The new research, by the University of California, San Francisco (UCSF), which was published in JAMA Network last month, have suggested the increase in cases across all ages, racial or ethnic groups, and regions. over the last 10 years is due screening guideline changes and a need for routine screenings.

UCSF researchers analyzed data of about 388,000 cases of prostate cancer in California men between 2004 and 2021. Out of all the cases, 28,000 men were found to have been diagnosed at an advanced stage. Additionally, 58, 754 prostate cancer deaths took place during the 17-year analysis.

Advanced prostate cancer cases were found to have risen 6.7 percent annually between 2011 and 2021, a worrying number as these same type of cases had been dropping or consistent prior to 2010.

In comparison, the study authors noted how the American Cancer Society (ACS) reported a 4.5% yearly rise in “regional and distant-stage prostate cancer between 2011 and 2019.”

Lastly, mortality rates were found to be decreasing annually by 2.6% from 2004 to 2012. In the years after 2012, the mortality rate was seen to remain at a steady level un most of the state’s region, with the San Francisco Bay Area having the least number of deaths.

The study authors concluded in their report, “In this cohort study among California residents, the incidence of distant stage prostate cancer increased throughout the state between 2011 and 2021.

“Mortality rates plateaued between 2012 and 2021, ending previous decades of decline. Implementation of more effective prostate cancer screening strategies are critically needed.

Van Blarigan, who works for the UCSF Helen Diller Family Comprehensive Cancer Center, said in a statement to UCSF, “Our data point to how urgent this problem is. Figuring out the best way to screen for prostate cancer continues to be a challenge for researchers and doctors.

“Without screening, the number of men diagnosed with advanced prostate cancer, when treatments are less effective, increases fast.”

The study’s lead author, UCSF associate professor of Epidemiology & Biostatistics and Urology,  Erin L. Van Blarigan, ScD, also said in a statement, “This overall rising trend is alarming and has occurred across age groups, regions of California, races and ethnicities.”

Remembering Dennis Hopper & His Battle With Prostate Cancer

Although prostate cancer often exhibits no symptoms, Dennis Hopper, n American actor and film director who also starred in “Blue Velvet,” “True Velvet,” was hospitalized for stomach pain and flu-like symptoms before being diagnosed in October 2009. This was a recurrence of the disease which, according to the New York Times, Hopper said had been first diagnosed ten years earlier.

The cancer had spread to his bones and he died on May 29, 2010 at his home in the Los Angeles beach community of Venice, surrounded by family and friends, family friend Alex Hitz told the Associated Press. His death took place seven months after his cancer diagnosis was announced.

Hopper was appearing in a television version of the movie Crash at the time. Weeks before his death, Hopper looked frail when he received a star on the Hollywood Walk of Fame, surrounded by friends including Jack Nicholson, actor Viggo Mortensen, and Blue Velvet director, David Lynch.

The two-time Academy Award nominee’s life and career was topsy-turvy. Married five times and known for his alcohol and drug abuse, Hopper got his start in Hollywood starring in two films with the original Hollywood bad boy James Dean.

His first major hit though was “Easy Rider,” which he directed and wrote with co-star Peter Fonda about two pot-smoking, drug-dealing hippies on a motorcycle trip. His work got him an Oscar nod for best screenwriting. His next film “The Last Movie” wasn’t as successful, prompting Hopper to be shunned by Hollywood for a decade, until he made a comeback in Francis Ford Coppola’s 1979 Vietnam War epic, “Apocalypse Now.”

Drugs and alcohol continued to hamper Hopper’s work, forcing him into rehab and Alcoholics Anonymous. In 1986, he made another comeback (and got another Oscar nomination) for starring as an alcoholic ex-basketball star in Hoosiers. The same year he won more acclaim for his role as a drug addict in Blue Velvet. He eventually returned to directing, with “Colors,” “The Hot Spot” and “Chasers.” He also made it to the top of the box office in the 1994 hit “Speed.”

Understanding Prostate Cancer

If you or a loved one has been diagnosed with prostate cancer, it’s important to remember that most types of prostate cancers are treatable. According to the National Cancer Institute, the five-year survival rate of prostate cancer in the U.S. is 97.1%. There is, however, a small number of men whose type of prostate cancer may become unresponsive to treatment, for example, when cancer cells develop a resistance hormone therapy, the treatment may no longer work.

Prostate cancer begins in the prostate the walnut-shaped gland located between the rectum and bladder that produces the fluid that nourishes sperm. Outside of skin cancers, prostate cancer is the most common cancer in American men with about one in eight men being diagnosed with this disease during his lifetime.

It’s important to remember a prostate cancer diagnosis is not always preceded by symptoms. And even when symptoms do occur, they can be inconsistent and hard to pinpoint.

Prostate Cancer: Symptoms & Diagnosis

“Prostate cancer is a very odd disease in that it doesn’t have a particular symptom,” Dr. Edwin Posadas, director of translational oncology and the medical director of the Urologic Oncology Program at Cedars-Sinai, previously told SurvivorNet.

After the Diagnosis: “What Did I Do Wrong?”

Still, it’s important to note changes in urinary function, like urinating more or less often or waking up at night to go more than usual, could be a sign of prostate cancer. So, even if you think there’s nothing to worry about, always talk to your doctor about changes to your health when they occur.

There are many different treatment options for both early and later-stage prostate cancer including active surveillance, watchful waiting, surgery, radiation, cryotherapy, hormone therapy, chemotherapy, immunotherapy and targeted therapy. The disease is one where doctors may have differing opinions on the best treatment path to take, so don’t hesitate to ask lots of questions and seek out multiple opinions.

Second (& Third) Opinions Matter When Deciding Between Surgery or Radiation

“I think it behooves the patient to have multiple discussions or second opinions, not only by the urologist who did the biopsy and diagnosed that man, but also with other surgeons and other radiation oncologist just to get a very circumspect view of what the treatment options are,” Dr. Jim Hu, a urologic oncologist at Weill Cornell Medicine, told SurvivorNet. “Oftentimes, I think patients need to understand that our health system is based a lot on fee-for-service medicine.

“And so therefore, a lot of physicians, I think, who are very well intentioned, will believe that their treatment is best for that particular man,” Dr. Hu added.

Prostate Cancer Screening Guidelines

It’s unclear if the benefits of prostate cancer screening outweigh the risks for most men. Nevertheless, screening can be life-saving, and it’s important to discuss the pros and cons of screening and your risk factors for the disease with your doctor.

The American Cancer Society (ACS) recommends “men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer” after “getting information about the uncertainties, risks, and potential benefits of prostate cancer screening.”

The ACS says the discussion about prostate cancer screening should take place at:

• Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
• Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).
• Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

When Should I Get Tested for Prostate Cancer?

Prostate cancer screening methods look for possible signs of the disease, but they can’t determine for sure if you have cancer. A prostate biopsy is the only way to confirm if the patient has prostate cancer.

Screening generally involves a PSA (prostate-specific antigen) test and a digital rectal exam to feel the prostate gland. The prostate-specific antigen is a protein secreted by the prostate gland, large amounts of which can indicate prostate cancer.

It’s slightly uncomfortable but painless, and takes less than 30 seconds,” Dr. Posadas said of these methods. “The amount of information that is gained from that is tremendous, and it can be a life-and-death type decision that is made.”

Though the PSA test is not always accurate and an elevated PSA test does not always mean you have prostate cancer, our experts maintain that these tests are helpful. Make sure to discuss your options with your doctors and decide what screening should look like for you.

Surgery Isn’t Always the First Option; Some Choose ‘Active Surveillance’

It’s common for prostate cancer to grow very slowly. Some men, especially those who are older and those who have a low risk of the cancer spreading, may not need aggressive treatment, making active surveillance a viable option.

WATCH: People With Low-Risk Prostate Cancer Can Rely on Monitoring the Disease

Active surveillance means the doctor watches the cancer carefully for changes, with a PSA blood test every six months and a digital rectal exam about once a year. You may also get prostate biopsies and imaging tests every one to three years.

SurvivorNet experts stress active surveillance is not “watchful waiting.” Active surveillance is a treatment, and as the name implies, it is active. This path requires coordination between the patient and their healthcare team.

“[It’s] not just kind of check in once a year—hey, how are you doing—but actively have a physician check a PSA and do a rectal examination,” Dr. Posadas, told SurvivorNet.

“We can actually see some of the metabolic information within the cells through our next-generation imaging and find high-risk areas that are or are not changing in a patient to let us know, yeah, that cancer’s still sleeping. Let’s not bother– let’s not put that young man through the risk of losing his sexual quality of life or his urinary quality of life,” Dr. Posadas added.

Half of men who choose this approach will avoid unnecessary treatment and potential side effects.

But the other half of men do end up having treatment, whether as a personal decision to remove the cancer or to treat the disease as it progresses. Your doctor will determine if this is necessary based on the results of your ongoing tests.

Contributing: SurvivorNet Staff

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