The prostate gland is situated beneath the bladder and surrounds a portion of the urethra.
Prostate cancer is one of the most prevalent cancers in men, as supported by statistical data.
It is also the most common prostate condition after benign prostatic hyperplasia.
However, it is not always diagnosed. Why is that? Because it is not always a fatal disease.
Hence, when detected in elderly individuals at an advanced age, the likelihood of succumbing to prostate cancer is significantly reduced.
This is why healthcare professionals often prioritize addressing other health issues instead of subjecting patients to a potentially painful diagnostic process and aggressive treatments for prostate cancer, which can impact the patient’s quality of life.
That is how prostate cancer statistics influence what doctors decide to do. They consider prostate cancer incidence and risk factors to know who should be screened. They also evaluate prostate cancer mortality and survival rate to determine who needs prompt treatment.
In this article, we’re going through prostate cancer statistics and showing you why they are so important. After this walkthrough, you will understand what each statistic represents and translate them into medical decisions.
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Prostate cancer incidence
Prostate cancer incidence is different in every country. If you compare the country with the least incidence with that of the highest incidence, you will find a variation of around 50-fold. The highest prostate cancer rate will be found in Australia, North America, and some countries in Europe. The lowest incidence is located in Northern Africa and Southern Asia (1,2).
That is why the attitude towards prostate cancer and screening could be different from country to country. In the United States, prostate cancer is widespread. Other developed countries in Europe follow a similar trend. According to national statistics, one in every six White men in the United States will get a diagnosis of prostate cancer at some point in their lifetime. The incidence is higher in African American men because one in every five is expected to receive this diagnosis.
If we go for the big number, more than 3 million men in the United States are currently living with a prostate cancer diagnosis. Hundreds of thousands will be diagnosed every year. In 2021, there will be an estimate of 248,530 cases, according to the American Cancer Society. Most of them will be over 50 years at the moment of the diagnosis (3).
It is also interesting to see how technology contributes to the diagnosis. If we look at statistics from 1989 and 1992, we will see a steep increase in prostate cancer incidence rates. But it is not because prostate cancer is now more common. It is because new technology and diagnostic tools are made available to detect prostate cancer in an early phase, sometimes in asymptomatic men. One of these tools is PSA testing (prostate-specific antigen) combined with a digital rectal examination (3, 4).
More recently, there has been a decrease in the incidence of low-risk prostate cancer. Compared to 2004, we had 37% fewer cases in studies performed in 2013. But this is hardly good news.
As the low-risk incidence declined, metastatic prostate cancer became more common. Compared to 2004, we had 72% more cases of aggressive prostate cancer in 2013. That is almost double the number of prostate cancer patients with metastasis (5).
In a nutshell:
- 1 in 6 White men and 1 in 5 African American men are diagnosed with prostate cancer
- There are more than 3 million men diagnosed with prostate cancer in the United States
- There will be an estimated 248,530 new prostate cancer cases in 2021
- Most cases are detected in patients over 50 years
- In recent years, there has been a decline of 37% in low-risk prostate cancer, but an increase of 72% in aggressive cancer statistics
With these statistics in mind, doctors decide when to screen for prostate cancer and how. After PSA screening became popular, the increase in prostate cancer incidence was not seen as a bad thing. Quite the contrary because it was evidence that more cases were being diagnosed in an early course.
But the most recent increase in aggressive cancer statistics is very alarming for the medical community. It means that we need to adjust our current screening strategies to detect those patients before cancer spreads.
This is how, by looking at statistics, health authorities adopt new policies and make changes in their protocols.
Prostate cancer mortality
Prostate cancer mortality is one of the most critical aspects studied by scientific literature. It is useful to understand prognosis, that is, what to expect from prostate cancer. Mortality depends on different factors:
- The Gleason score: This is a measure of aggressiveness in prostate cancer. Doctors perform a prostate biopsy and see how prostate cells look like. When cancer cells are very different from normal cells, the risk is higher.
- The extent of the tumor: Tumor volume is also essential, especially when it is starting to spread locally. Small tumors are less likely to spread to distant organs.
- Margin positivity: When doctors take out cancer in surgery, they will also take out the tissue all around it. This is the margin of the tumor. Margins are also studied to see if there is prostate cancer. When margins are also taken by cancer cells, the risk of spread is higher. Even when the tumor was taken out, the prognosis is less favorable.
Mortality does not always depend on the treatment modality. For example, not all patients with prostate cancer will undergo surgery. Some of them will only require active surveillance (a conservative wait-and-see approach). Others will benefit from radiotherapy and chemotherapy instead. But regardless of the treatment, if we follow the recommendations, mortality rates decrease.
For example, there was a systematic review with patients who underwent radical prostatectomy. The researchers reviewed data from over 11,000 patients. They reported that mortality from prostate cancer was only 7% after 15 years. So, patients who need surgery will reduce their mortality significantly by following recommendations. In most cases, this 7% of people who died within 15 years had a local invasion of the seminal vesicles or cases of high-grade cancer (6).
It is clear that spread is the most critical factor that speeds up prostate cancer mortality. Thus, medicine has made advancements trying to reduce the incidence of spread in prostate cancer.
We have reached a significant improvement and detect more early cases as opposed to metastatic disease. Instead of 20% of metastasis at the moment of diagnosis in 1970, our current number dropped to 3.4%. That is good news. However, even if we detect prostate cancer very early, 30% of these patients will have a spread of the disease regardless of the treatment.
Are you counted in this 30% of cases? To answer this question, doctors use something called cancer of the Prostate Risk Assessment Score (CAPRA). This is a useful way to predict prognosis in patients with prostate cancer. It considers five items (7):
- PSA level: Prostate cancer cells usually increase PSA levels very aggressively. Higher or very sudden increases offer a very bad prognosis. These patients have increased mortality because their disease is more likely to progress.
- Gleason score: Even if the tumor is localized in the prostate and relatively small, the mortality is higher if the Gleason score is high. The Gleason score uses a number from 6 to 10. Higher numbers mean more aggressive cancer. What doctors do is looking at the tumor in the microscope and comparing cancer cells to normal tissue. The more differences they find, the highest the Gleason score will be, and mortality will also increase.
- Percentage of positive biopsy cores: In a prostate biopsy, doctors do not only take one sample. They take several samples from the tumor and the surrounding tissue. This tissue may appear normal in imaging tests, but it can turn out to be positive in biopsies. More positive biopsy cores traduce into a higher spread risk and mortality rate.
- Clinical tumor stage: Staging of the tumor uses the TNM system. It takes data from the tumor, the lymph nodes, and the existence of distant metastasis. The tumor can be very small (T1) or very large and invading adjacent organs (T4). The lymph nodes can be taken by cancer (N1) or not (N0). Similarly, the patient may not have a distant spread of the disease (M0) or have spread cancer cells in distant organs (M1c). As the disease advances, the numbers go up, and the mortality rate increases.
- Age of diagnosis: Prostate cancer is very rare in young patients. It is more common after age 65 years, and these patients have a better prognosis. If you were diagnosed with prostate cancer as a young man, your disease would likely be more aggressive. One would think that young men have better possibilities to survive than older men. However, that is not how prostate cancer behaves. This type of cancer develops very slowly.
So, young men have a longer life expectancy to develop all of the complications. Additionally, if prostate cancer shows up in a young man, it is because he has several risk factors contributing to an early-onset disease. He may have a genetic predisposition for a very aggressive disease. Thus, his mortality rate as a young man is higher than that of seniors.
This tool is useful to predict all-cause mortality and cancer-specific mortality. It also predicts the risk of metastasis in patients with early detection. Thus, it is helpful at the moment of diagnosis and throughout the disease, even after patients undergo radical prostatectomy, androgen deprivation therapy, radiation therapy, watchful waiting, active surveillance, or another treatment modality (7).
Besides the factors named above, a few others can also increase mortality. One of them is tobacco smoking. Men who smoke at the moment of diagnosis are more likely to develop aggressive prostate cancer. As you increase the number of smoked cigarette packs a year, the risk of prostate cancer mortality increases. If you quit smoking and used to smoke fewer than 20 packs a year, the risk will be similar to the baseline. Also, if you stopped smoking 10 years before the diagnosis, the mortality risk is similar to the general population (8).
In a nutshell, prostate cancer mortality depends on:
- The Gleason Score
- The extent of the tumor
- Margin positivity in radical prostatectomy
- The levels of PSA testing
- The percentage of positive biopsy cores
- The TNM staging system
- The age of diagnosis
Prostate cancer survival
As we mentioned in the article’s introduction, prostate cancer is not invariably a fatal disease. In the section above, we also noted that it grows very slowly in most cases.
The mortality rate mentioned above was 7% after 15 years for patients who undergo treatment. That is actually a very low mortality rate as compared to other types of cancer.
Prostate cancer survival rate is much better than other cancers. In fact, most males are likely to have prostate cancer by age 80 years without even realizing it. They die from unrelated causes because their cancer cells are not aggressive. That’s why doctors use a survival rate to make a decision after getting a new diagnose.
According to the American Society of Clinical Oncology, the survival rate is 98% in 10 years and 96% in 15 years. Of course, this is the baseline, and it can be modified by factors mentioned above that increase the mortality rate. However, most patients are still alive after 15 years, which is excellent news (9,10).
Still, it is not wise to be overly optimistic because there will always be a case of aggressive prostate cancer. Thus, do not neglect your condition, be aware of your urinary symptoms, and understand prostate cancer risk factors. If you have a doubt or concern and have alarming symptoms, do not hesitate to talk to your doctor about it.
In a nutshell:
- The survival rate is 98% after ten years and 96% after 15 years
- This is the baseline survival rate and should be adjusted according to your risk factors
- We can’t be too optimistic and neglect prostate cancer and its symptoms because there will always be an individual with aggressive disease
Prostate cancer risk
Another useful statistic is that of prostate cancer risk. When doctors understand risk factors, they know who is more likely to develop prostate cancer. All of this is taken from age-related demographics, racial demographics, and other statistics.
Age-related demographics compare prostate cancer incidence with the patient’s age. After studying these statistics, we can say that prostate cancer risk increases as we age. According to US numbers, up to 60% of men are diagnosed with prostate cancer when they reach 65 years.
The number of cases reaches 80% at 80 years, but older adults after 75 years are not screened, and many of them won’t likely know they have cancer and die from unrelated causes. The age of diagnosis is usually 65 to 74 years, with a median of 66 years of age (4).
However, that does not release younger patients from the chance of having this disease. Prostate cancer can be detected in very young patients. It is not common, and it is actually more dangerous, as noted above. However, the incidence of young patients with prostate cancer is increasing in the United States and the world. This is particularly concerning because young patients have a longer lifespan to develop prostate cancer’s worst complications.
Additionally, as noted above, they probably have a predisposing genetic factor. Thus, cancer spreads more rapidly, and they are six times more likely to have a metastatic or aggressive disease at the moment of diagnosis (11).
Racial demographics evaluate the incidence of prostate cancer in relation to the phenotype. As noted above, African American people are more likely to get a diagnosis of prostate cancer. They are also twice as likely to die from prostate cancer, so their disease is more aggressive. The incidence is even lower in Hispanics as compared to White men and lower still in Asians (12).
The country of residence is another risk factor to consider. According to statistics, prostate cancer is more common in developed countries. Thus, if you live in a country with a high socioeconomic index, your risk will likely be higher (13).
Additionally, your risk is higher if you have a family history of prostate cancer or a genetic predisposition. Family history only counts in first-degree relatives (father and brother). When either of them is affected by prostate cancer, your risk is 68% higher. You might also have a predisposition if your sister or mother had breast cancer. If either of them is affected by breast cancer, your risk is 21% higher (14).
Many other factors can also increase the risk of prostate cancer. For example, being overweight or obese and having metabolic syndrome. Tobacco smoking may also increase the risk.
In a nutshell:
- The most common age of diagnosis is 65 to 74 years
- Young patients diagnosed with prostate cancer are 6 times more likely to have advanced prostate cancer at the moment of diagnosis
- African Americans are more likely to be diagnosed, followed by White men, than Hispanics, and Asians
- The risk is higher in patients who live in developed countries
- The risk is 68% higher if you have a brother or father with prostate cancer. It also increases 21% if your mother or sister develops breast cancer.
Conclusion
Prostate cancer statistics are important to understand what to expect from the disease. Its incidence is higher as we age, especially in African American men living in developed countries. Prostate cancer death rate is not very high but can be increased by different factors such as the Gleason and TNM score, the extent of the tumor, and the age of diagnosis.
Cancer screening is an essential tool for the early detection of prostate cancer. The main focus of screening should be patients with risk factors, especially age (65 to 74 years), race (African Americans), family history (in first-degree relatives), and those who display symptoms of prostate enlargement.
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