‘The Enemy You Know, You Can Prepare For:’ Prostate Cancer Cases Are Rising—Experts Warn of Missed Screenings

“The enemy you know you can always prepare for,” says Dr. Eleni Efstathiou, a leading prostate cancer medical oncologist from Houston Methodist, in an interview with SurvivorNet.

WATCH: Understanding Monitoring & Recurrence In Advanced Prostate Cancer

“We decided to limit knowledge rather than educate physicians on how to make the most of the knowledge, and this is the price we pay whenever we act in a ‘medieval’ attitude,” Dr. Efstathiou added.

“These guidelines aim to balance the potential benefits of early cancer detection with any risks associated with screening and treatment,” Dr. Jeffrey Jones, a urologic surgeon at Baylor College of Medicine in Houston, tells SurvivorNet.

Dr. Jones says his office remains largely undeterred from outside voices and follows the recommended prostate cancer screening guidelines, and emphasizes that there is “high value in early detection.”

The study points to a possible reason why fewer men were getting recommended prostate cancer screening, which claimed the protein-specific antigen (PSA) test led to overdiagnosis.

The PSA test is a simple blood test that screens for prostate cancer. It looks for more significant amounts of protein-specific antigen in the blood. An elevated PSA test does not always mean you have prostate cancer. It could also reflect that your prostate is enlarged, which is common, or it could signal an infection or inflammation.

A 2002 study published in the Journal of the National Cancer Institute, analyzing data from 1988 to 1998, found that among men whose prostate cancer would have gone undetected until autopsy, overdiagnosis rates were estimated at up to 15% for White men and 37% for Black men. These cases involved cancers that likely would not have caused symptoms or required treatment during the patients’ lifetimes.

In response, the United States Preventive Services Task Force – an independent panel of national experts in primary care, disease prevention, and evidence-based medicine – reacted to this data by recommending “against” PSA-based screening in 2008.

However, researchers in the American Cancer Society’s study point to this change as a possible contributing factor to “an increase in advanced prostate cancer diagnoses” as prostate cancer incidence rates started climbing after the USPSTF recommendation change.

WATCH: What Happens if My PSA Test is Elevated?

The prostate cancer screening and diagnosis process is not solely reliant on the PSA test, although it can offer major clues to the onset of cancer.

“PSA testing is only part of the decision whether further testing is needed,” Dr. Kevin Kelly, a medical oncologist at Thomas Jefferson University, tells SurvivorNet.

As the American Cancer Society’s study highlights, a concerning consequence of loosening recommended screening guidelines out of fear of overdiagnosing men, Dr. Kelly says screening may not be perfect, but it still has immense benefits.

“It does identify cancers earlier in their disease course, which can be curable. PSA is a tool that should be used in conjunction with all patient information to facilitate discussions with patients about the risks and benefits of PC screening,” Dr. Kelly explained.

Fewer Prostate Cancer Screenings, More Prostate Cancer Cases

Digging deeper into the study in CA: A Cancer Journal for Clinicians, prostate cancer incidence rose by up to 3% annually between 2014 and 2021. Even more concerning, metastatic cases—where the cancer has already spread—accelerated at a rate of 4.6% to 4.8% per year.

This marks a stark contrast to the years prior. From 2007 to 2014, incidence rates fell by 6.4% annually, largely due to widespread PSA (prostate-specific antigen) screening. But after the U.S. Preventive Services Task Force recommended against routine PSA testing—citing concerns about overdiagnosis and overtreatment—advanced-stage diagnoses began to climb.

“Subsequent recommendations against PSA testing… coincided with an increase in advanced prostate cancer diagnoses that has continued through 2021,” the report states.

Some oncologists argue that the pendulum has swung too far.

WATCH: When Prostate Cancer Spreads: The Scans Doctors Use To Assess Advanced Disease

“We are observing the diminished early detection that has resulted as a consequences of the years the USPSTF listed Prostate Cancer screening as a “D Recommendation” i.e. not recommended, which was adopted by the American Academy of Family Practitioners, and other primary care groups and resulted in many men not being offered PCA screening, until the USPSTF recommendation changed back to a “C Recommendation” under high pressure from the AUA and other groups,” Dr. Jones explained.

Dr. Efstathiou advocates for thoughtful, individualized screening—not blanket avoidance. “The knowledge that arises from appropriate and thoughtful screening is invaluable,” she said. “It allows appropriate monitoring and actions that can be taken, depending on the case scenario, and can be a huge game-changer.”

She also emphasized that even low-risk cases deserve proactive care. “Recommendations are not just passive monitoring but are more focused on changing lifestyle practices that may enhance the inherent immune response.”

Enhanced Imaging Is Helping Refine Prostate Cancer Screening

Imaging technology, such as the prostate-specific membrane antigen (PSMA) positron emission tomography-computed tomography (PET-CT) scan, can help doctors accurately diagnose and stage prostate cancer. It detects clusters of prostate cancer cells anywhere in the body.

PSMA PET-CT scans are especially useful for men with prostate cancer at high risk of it spreading outside the prostate gland or those who have recurrent cancers.

“PSMA-PET scans have revolutionized our ability to find extra-prostatic prostate cancer,” Dr. Jones tells SurvivorNet.

Dr. Bilal A. Siddiqui, Assistant Professor, Department of Genitourinary Medical Oncology at The University of Texas MD Anderson Cancer Center, says improved imaging scans have improved detection of cancer outside the prostate, helping patients discover more advanced-stage disease.

“We are observing a phenomenon known as ‘stage migration,’ where more sensitive scans are detecting more potential cancers outside of the prostate. Studies are ongoing to determine the long-term effects of these findings,” Dr. Siddiqui tells SurvivorNet.

What Are the Current Prostate Cancer Screening Guidelines?

The Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) both recommend that men at average risk between the ages of 55 and 69 years talk with their doctor about the pros and cons of prostate cancer screening.

The American Cancer Society recommends that men at age 50 who are at average risk should begin screening. Men who are at high risk of prostate cancer should begin screening at age 45. Men with a close relative diagnosed with prostate cancer should consider annual screening at 40.

For men 70 years and older, the USPSTF and the CDC say potential benefits do not outweigh the expected harms and recommend that men 70 and older should not be routinely screened for prostate cancer.

Existing Racial Disparities In Prostate Cancer Cases

The report also highlights deep racial disparities in prostate cancer outcomes. Black and Native American men face significantly higher mortality rates than White men—despite differences in incidence.

RELATED: How Military Service Combats Racial Gaps in Prostate Cancer Survival

“Compared with White men, American Indian/Alaska Native men have 12% higher prostate cancer mortality despite 13% lower incidence, whereas Black men have double the prostate cancer mortality, with 67% higher incidence,” the study notes.

“Prostate cancer affects men of all walks of life, but it affects them differently,” says Dr. Edwin Posadas, Director of Translational Oncology and the Medical Director of the Urologic Oncology Program at Cedars-Sinai. For example, the incidence of prostate cancer in African-American men is 60 percent higher, and they are two to three times more likely to die from the disease.

WATCH: Higher Prostate Cancer Rates for Black & Latino Men

“Latino men may not develop prostate cancer at the same rate as African-American men,” says Dr. Edwin Posadas, Director of the Translational Oncology Program, and Medical Director of the Urologic Oncology Program at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center.

Dr. Posadas adds that “there are problems that exist within the lifestyle that are accelerating. And although prostate cancer is rarer in Asian men, when they do get it, it tends to be more aggressive.”

These findings underscore that the oncology field must improve its methods to educate and encourage communities of color to engage more in prostate cancer screening, so early detection is more commonplace.

Treating Prostate Cancer

Prostate cancer symptoms may include:

• Urinating more often
• Waking up in the middle of the night to pee
• Blood in your urine
• Trouble getting an erection
• Pain or burning when you urinate
• Pain in your back, hips, thighs, or other bones
• Unexplained weight loss
• Fatigue

If You’re Diagnosed With Prostate Cancer, What to Expect for Treatment?

After testing and establishing your risk, your doctor will discuss possible treatment options. These may range from active surveillance to more aggressive options, including surgery and radiation therapy.

Surgery is an option for men with any risk group of prostate cancer that hasn’t spread outside of the prostate gland. The type of surgery most often used is called a radical prostatectomy.

During the procedure, the surgeon removes the entire prostate, along with some tissue around it, including the seminal vesicles that release fluid into the semen. Your doctor can perform this through a traditional open procedure with one large or several small incisions, called laparoscopic surgery.

WATCH: Sexual Function Recovery After Prostate Cancer Surgery

Surgery side effects may include erectile dysfunction and urinary incontinence. Fortunately, the side effects are usually temporary, and there are ways to help you manage them.

“Erectile function is so sensitive when we’re dealing with prostate cancer because the nerves that are critical for this function wrap around the prostate; they’re just so intimately connected to the prostate that they can be damaged from a surgical removal of the prostate or through radiation treatment,” Dr. Isla Garraway, a staff urologist in the Veterans Administration (VA) Greater Los Angeles Healthcare System, told SurvivorNet.

Doctors often recommend sexual counseling after prostate cancer treatment to help improve sexual function. This approach actively addresses the psychological, emotional, and relationship impacts on sexual health.

Radiation therapy is often done when prostate cancer is caught early and confined to the prostate gland.

Questions for Your Doctor

If you have experienced symptoms associated with prostate cancer or have a screening coming up, here are some questions you may ask your doctor:

• If I had elevated PSA levels, what could be causing that besides cancer?
• How long will it take to learn if my PSA levels warrant further testing?
• What are the treatment options that are best suited for me based on my risk level?
• What financial resources exist to help me with the costs associated with treatment?
• How long will my potential treatment prevent me from working or continuing normal activities?

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