Annual prostate cancer cases worldwide are projected to double by the 12 months 2040, and annual deaths are projected to extend by 85% to almost 700,000 over the identical timeframe – mainly amongst men in low- and middle-income countries. A commissioned report published online in The Lancet on April 4 highlights the longer term landscape of prostate cancer and seeks to guide cancer experts worldwide on manage the large influx of prostate cancer patients projected over the subsequent 20 years.
Brandon Mahal, M.D., radiation oncologist and translational epidemiologist at Sylvester Comprehensive Cancer Center on the University of Miami Miller School of Medicine was a member of a prestigious group of international experts commissioned to put in writing the collaborative article.
Unlike a typical study, which describes a single or set of experiments, commissioned pieces involve The Lancet editors working with academic partners to handle essentially the most pressing issues in science, medicine and global health.”
Brandon Mahal, M.D., radiation oncologist and translational epidemiologist, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
He said the report was conceived back in 2020, when the journal’s editors sought advice from a select group of 40 cancer experts to focus on the increasing burden of prostate cancer, with global cases projected to greater than double by 2040. “Specifically, they wanted our collective, international perspective on this looming global burden,” he said. “They asked us to report the extent of the issue, discover essentially the most at-risk populations and explain how best to handle the expected surge.”
Besides outlining the scope of the issue – worldwide cases are expected to blow up from 1.4 million now to 2.9 million in only 16 years – The Lancet report highlights each ethnic and geographic disparities in the general burden of prostate cancer and emphasizes the necessity for more research into the aspects driving these differences.
That is an area right in Mahal’s wheelhouse. As a translational epidemiologist, he studies differences in disease risk amongst populations. “Men with West African ancestry, for instance, are greater than twice as prone to die from prostate cancer,” he said.
Moreover, he and his Sylvester research colleagues have published studies showing that racial and ethnic disparities in prostate cancer prevalence can’t be explained by genetic differences alone.
In 2023, Mahal and his team published a paper showing that men of African ancestry were less likely than their European counterparts to get comprehensive genetic profiles of their tumors early in treatment. Genetic profiling helps physicians develop personalized treatment plans which have been proven more practical in treating prostate cancer. Patients without this initial profiling often receive substandard care.
Expanding community outreach
The authors noted that top-of-the-line ways to enhance prostate cancer outcomes is to expand screening amongst high-risk populations in order that the disease might be diagnosed at earlier stages, when treatment is often best.
At Sylvester, Mahal works with a team dedicated to precision community outreach. “We’ve focused our efforts in neighborhoods where we all know there’s a better risk of developing prostate cancer,” he explained, “and we use our mobile vehicles to bring the screenings right to those residents.”
The mobile vans, dubbed Sylvester’s Game Changers, enable Mahal and colleagues to focus on high-risk people by conducting the screenings at key community sites, including near workplaces, stores and libraries, and at health fairs and other events. The vans are staffed by professionals who speak English, Spanish and Creole to make sure they’ll communicate with people of their native languages.
Not surprisingly, The Lancet report identifies mobile vans as a key strategy for providing earlier diagnoses in high-risk populations.
Other takeaways
Other key recommendations from The Lancet report include:
- Integrating the facility of artificial intelligence for interpretation of scans and biopsy samples to enhance early diagnosis.
- Focusing more broadly on men’s health beyond prostate cancer.
- Capitalizing on the worldwide availability of smartphones in outreach efforts, in addition to using social and traditional media to advertise education.
- Ensuring reasonably priced therapies for advanced prostate cancer can be found where needed most.
- Addressing the shortage of specialist surgeons and radiotherapy equipment in low- and middle-income countries (LMICs).
- The Lancet Commission on prostate cancer argues that the ‘informed alternative’ program for prostate cancer screening with PSA testing, which is common in high-income countries, may result in over-testing and unnecessary treatment in older men, and under-testing in high-risk younger men. The authors advocate as a substitute for early-detection programs for those at high risk.
- The Commission also calls for urgent implementation of programs to lift awareness of prostate cancer and for improvements in early diagnosis and treatment in LMICs – where most men present with late-stage disease.
- More research involving men of various ethnicities, especially those of West African descent, is required, as current knowledge of prostate cancer biology is essentially based on studies of white men.
Unified message
Although The Lancet report delivers a sobering message that lifestyle or public health interventions will likely be insufficient to stem the expected tsunami of prostate cancer cases – and that minority populations and people in LMICs will bear the brunt of this burden – Mahal stays optimistic about his involvement with the project.
“This report creates a unified message for all so we might be best equipped to handle this surge in prostate cancer cases,” he said. “Whether it’s different medical systems, national or international guidelines, institutions or community practices, we took great pride in our work and imagine it may well be a reference document for where to focus our efforts moving forward.”