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Movember: an opportunity for prostate cancer awareness to promote earlier diagnosis (Guest blog)

Prostate cancer is one of the most prevalent malignancies amongst men in Europe, with an estimated 473,000 new diagnoses each year.[1] This equates to around one in eight men being diagnosed with prostate cancer during their lifetime. These figures make prostate cancer the second most common cancer in men and the fifth leading cause of mortality worldwide.[2]
 
Together we can raise much needed awareness about prostate cancer. Awareness campaigns such as Movember, which support open conversation on men’s health, promote education and risk adapted prostate check-ups for well-informed men, in order to enable early diagnosis, improve outcomes and better address this significant burden.[3],[4]
 
The importance of early diagnosis
 
Early diagnosis is a key factor for the improvement of treatment outcomes – the earlier the cancer is diagnosed, the greater the odds of remission and overall survival.[5],[6] If diagnosed early, the cancer is usually limited to the prostate and is considered localized. This increases the likelihood of successfully treating and curing the disease.5,[7]
 
In late diagnoses, there is a greater chance that the cancer has metastasized and spread to other organs, making long-term survival a challenge. The five-year survival rate for stage four prostate cancer is 50%, a drastic reduction compared to almost 100% survival rate seen in people with localized stage one or two disease.[8] Late-stage prostate cancer is also associated with a dramatic decline in overall quality of life.[9] This decline is worsened by some of the treatments administered in these cases.9
 
Age, ethnicity, family history, and lifestyle factors – including smoking, drinking, diet, and physical activity – are key risk factors increasing the chances of prostate cancer.2 Encouraging testing, especially for those with several risk factors, is imperative to promote early diagnoses. Importantly, while there has been concern about the effectiveness and impact on quality of life of PSA screening and potential associated invasive diagnostics and therapies, with the growing understanding of risk factors and advent of improved imaging, the oncology community are now much better enabled to differentiate between significant and insignificant prostate cancer in order to provide accurate diagnoses and appropriate treatment plans.[10],[11] Achieving this requires raising increased awareness of the impact of prostate cancer on quality of life and the importance of early diagnoses. With the growth of large-scale awareness campaigns, such as Movember, highlighting the symptoms and risk factors, more people may feel empowered with the information they need to seek out a diagnosis and receive treatment earlier.3,[12]
 
Challenges in the management of prostate cancer
 
Prostate cancer most often does not present with initial or early symptoms, whilst late symptoms may include difficulties and / or pain urinating, fatigue and bone pain.[13] Therefore, identifying prostate cancer in its early stages is a challenge which relies on effective screening and testing.
 
Challenges have also existed around the value of screening for prostate cancer; whilst historically, a prostate-specific antigen (PSA) screening has been recommended for early detection of prostate cancer, evidence around the effectiveness of a PSA based screening has been controversial.11 While men with a life expectancy of more than ten years benefitted from PSA screening and lived longer compared to unscreened men, at the same time, men undergoing PSA screening were also at risk of overdiagnosis and overtreatment.[14]  Nevertheless, with the abandoning of routine PSA screening we observe a trend of more men being diagnosed with late-stage prostate cancer in these countries, making it more difficult to treat and reducing the chance for cure.[15] At the same time, with improved understanding of the molecular biology of prostate cancer, improved understanding of the PSA value and dynamics, in terms of risk for developing prostate cancer and availability of advanced imaging, a risk-adapted screening strategy tailored to an individual’s personal situation, allows an improved early detection of prostate cancer and avoidance of overdiagnosis and overtreatment.10
 
The stigma surrounding prostate cancer represents another prevalent challenge, which may lead to men avoiding screening. Research has shown that some men view a prostate cancer diagnosis as “an emasculating journey”.[16] Many others are hesitant to express their concerns to their families and friends, instead preferring to keep their worries private. Overcoming this stigma and breaking down screening barriers is vital and requires education and open conversation.
 
The role of personalized medicine in the future of prostate cancer care
There are also several challenges associated with treatment. When selecting treatment for prostate cancer, a balance is struck between potential side effects and efficacy of the intervention. In particular, in the setting of early, localized disease it may be difficult to strike the balance between a more aggressive treatment plan, which may be bring a higher likelihood for cure but at the same time may be associated with more side effects, compared to a less intensive therapy. [17],[18] Fortunately advanced imaging and molecular profiling has enabled the oncology community to better risk-stratify the disease, enabling a more tailored approach in designing the best therapy for each man, optimizing potential side effects with outcomes.[19]
 
[1] IARC. GLOBOCAN 2020. Available at: bit.ly/3T7KbG5. Accessed November 2022.
[2] Rawla P. Epidemiology of Prostate Cancer. World J Oncol. 2019;10(2):63-89.
[3] Movember. About Us. Available at: https://uk.movember.com/about/prostate-cancer. Accessed November 2022.
[4] Royal Holloway University of London. Movember – Men’s Health Awareness Month. Available at: https://intranet.royalholloway.ac.uk/staff/your-employment/human-resources/organisation-development/working-well-from-home/weekly-wellbeing-focus-movember.aspx. Accessed November 2022.
[5] Why early detection for prostate cancer is vital. Uroweb. Available at: https://uroweb.org/news/why-early-detection-for-prostate-cancer-is-vital. Accessed November 2022.
[6] World Health Organisation. Promoting Cancer Early Diagnosis. Available at: https://www.who.int/activities/promoting-cancer-early-diagnosis. Accessed November 2022.
[7] Cancer.Net. Prostate Cancer: Statistics. Available at: https://www.cancer.net/cancer-types/prostate-cancer/statistics. Accessed November 2022.
[8] Cancer Research UK. Survival of prostate cancer. Available at: https://www.cancerresearchuk.org/about-cancer/prostate-cancer/survival. Accessed November 2022.
[9] Europa Uomo. The EUPROMS Study: Quality of Life. Available at: https://www.europa-uomo.org/who-we-are/quality-of-life-2/the-euproms-study/#section-4. Accessed November 2022.
[10] Van Poppel H, et al. Prostate-specific Antigen Testing as Part of a Risk-Adapted Early Detection Strategy for Prostate Cancer: European Association of Urology Position and Recommendations for 2021. Eur Urol. 2021 Dec;80(6):703-711.
[11] NHS. PSA testing. Available at: https://www.nhs.uk/conditions/prostate-cancer/psa-testing/ Accessed November 2022.
[13] Leslie SW, et al. Prostate Cancer. Nat Lib of Medic. 2022. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470550/. Accessed November 2022.  
[14] Kohestani, K, et al. Prostate Cancer Screening – When to Start and How to Screen? Translational Andrology and Urology. 2018;7(1)
[15] Gaylis, FD, et al. Change in prostate cancer presentation coinciding with USPSTF screening recommendations at a community-based urology practice. Urol Oncol. 2017;35(11):663
[16] Buote R, Cameron E, Collins R, McGowan E. Understanding Men's Experiences With Prostate Cancer Stigma: A Qualitative Study. Oncol Nurs Forum. 2020;47(5):577-585.
[17] Lardas, M, et al. Quality of Life Outcomes after Primary Treatment for Clinically Localised Prostate Cancer: A Systema. European Urology. 2017:72(6):869-885
[18] InformedHealth.org [internet]. Localized prostate cancer: Low-risk prostate cancer: Active surveillance or treatment? Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG). 2006 [updated 2020 Mar 12].
[19] Patel, D, et al. Next-generation imaging in localized high-risk prostate cancer. Prostate Cancer and Prostatic Diseases. 2021;24:585-586

Martin Vogel

Martin Vogel is Therapeutic Area Lead Oncology at Janssen Europe, Middle East & Africa
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