Prostate cancer cases have increased after years of decline. Evan Goldfischer, president of LUGPA, talks about the need to increase awareness and outreach.
After years of progress, more men are being diagnosed with prostate cancer.
Incidences of prostate cancer rose 3% annually from 2014 through 2019, translating to an additional 99,000 new cases and ending two decades of declines, the American Cancer Society reported earlier this year. About one in 8 men will be diagnosed with prostate cancer.
For Evan Goldfischer, the rise in prostate cancer cases is troubling and frustrating. Goldfischer is a urologist and the president of LUGPA, the nonprofit urology trade association. With September recognized as Prostate Cancer Awareness Month, Goldfischer is trying to draw more attention to the uptick in cases and pushing for more action.
“We now have many more patients presenting with advanced disease,” he says.
Healthcare advocacy groups are backing measures from Congress designed to get more men screened.
This month, U.S. Sens. Cory Booker D-N.J., and John Boozman, R-Ark., introduced a bill that would require insurers to cover the costs of prostate cancer screenings for those at high risk. The bill is called the Prostate-Specific Antigen Screening for High-risk Insured Men Act. Several House members introduced a similar bipartisan bill in March. Goldfischer is optimistic the legislation could make a difference.
Goldfischer is pushing for more screening of all men, but says there needs to be more work to reach out to Black men in particular. There’s disturbing disparities in prostate cancer rates, according to American Cancer Society research.
“Black Americans get prostate cancer in a more aggressive fashion,” Goldfischer says. “And they get it more commonly than Caucasian men.”
Black Americans are more likely to be diagnosed with prostate cancer than men in other racial groups, and Black men with prostate cancer are two to four times more likely to die than men of any other racial or ethnic group, according to American Cancer Society data. Goldfischer said it’s imperative for more Black men to be screened for prostate cancer.
“Black Americans don't have the same access to prostate cancer screening that Caucasians do,” Goldfischer says. “They get the disease worse and more frequently than Caucasians do, and now they're not being screened in the way that they should be screened.
“And you don't necessarily have enough culturally sensitive doctors who are explaining to the Black patients when they come into their visit, why they should consider screening as an option,” he added. “And these patients are left without getting screened for prostate cancer, which they probably should.”
Healthcare providers need to examine the zip codes where patients have higher rates of prostate cancer and expand their outreach efforts to reach communities with higher percentages of Black residents and other underserved groups, Goldfischer says.
“It's really getting out there into those communities …. and really starting an outreach and doing it in a very kind, compassionate and trustful way,” Goldfischer says.
The U.S. Preventive Services Task Force recommends that men 55-69 discuss with their doctors if they should be screened for prostate cancer. The task force doesn’t recommend screenings for those 70 and over. In 2012, the task force had advised against PSA-based screening for prostate cancer altogether, but they revised their recommendations in 2018 to suggest patients make an individual choice.
Goldfischer says the drop in screenings tied to those recommendations has played a role in the rise of prostate cancer cases.
“We still are behind in screening men for prostate cancer,” he says. “And as a result, we have been presenting that with much more advanced disease.”
From Goldfischer’s perspective, he would prefer to see recommendations for regular screenings for men beginning at age 50, and at age 40 for men with a family history.
Goldfischer suggests that older patients probably shouldn’t be screened if they have a variety of health issues. But for older patients who are healthy and have a reasonably good chance of living an additional 10 years, he said there should be at least a discussion with a physician.
While conceding that primary care physicians are juggling many demands and often have limited time with patients, Goldfischer says that they should initiate discussions with some of their male patients.
“It's got to start with the primary care doctor,” he says. “They're the gatekeepers.”
For patients leery of getting screened, Goldfisher says they need to think beyond themselves.
“Don't do it for yourself,” he says. “Do it for your family. Think about all the people who are going to be left behind to pick up the pieces if you die of prostate cancer, which is a disease if it’s caught early, it's very treatable.”