Florida Bill Doing Best To Out-Worst All Other Bans On Gender-Affirming Care

As Yr Wonkette covered yesterday, and as brought to our attention by the invaluable Erin in the Morning, the state of Florida (Motto: “America’s Useless Appendage”) is considering a whole swath of terrible legislation that if passed, would make life even more miserable for LGBTQ+ people there. It’s understandable, really — there are so many Republicans in the state Legislature, and they all want a turn at proving that they can hate LGBTQ+ folks as much or more than their peers.

Read More:

Florida LGBTQ Hate Bills Want Some Bigot To Have ‘Parental Rights’ Over Everybody Else’s Children

Red States About Five Minutes Away From Legalized Lynching Of Trans People

What IS Gender Affirming Health Care For Kids Anyway, Because Texas Is Super F*cking Lying About It Right?

Today, we’ll take a closer look (again, thanks to Erin Reed) at just one of those very bad ideas, Florida HB 1421, which drunkenly tells other states’ bans on gender affirming care for trans youth, “Hold my beer” before jumping on a skateboard and launching itself into the abyss. A Florida House subcommittee yesterday voted to move HB 1421 out of committee. After hearings in a second committee, the bill is likely to be sent to the full House, where it’s likely to pass. It’s Florida, and Republicans have an 85-35 majority of seats.

It’s not only an extremist bill, it’s also so broadly written that in attempting to outlaw gender-affirming care for minors, it also may make mastectomies for breast cancer illegal and ban hormone treatments for menopause. We can’t entirely guarantee that’s a mistake. The bill doesn’t simply ban gender-affirming treatment going forward: It would force detransition on trans youth. All minors currently receiving puberty blockers or hormone replacement therapy would have to end treatment by December 31 of this year. Such forced detransitioning is almost certain to lead to suicides, not that the psycho bigots supporting the bill care.

As ever: If you’re having thoughts of harming yourself, call the national suicide and crisis lifeline at 988.

This being Florida, the bill keeps getting worse. One provision would allow the state to take trans kids from their parents to “protect” them from getting gender-affirming care in another state.

As with several similar bills around the country, the law also forbids insurance plans from covering gender-affirming care for adults, because the bill’s sponsor, the dubiously named Rep. Randy Fine — a former gambling industry executive, not a doctor — says he believes all medical care for trans people is merely “a cosmetic-type procedure, and not necessarily a procedure that would improve their health.” Yes, of course he’s ignoring the consensus among medical organizations that transition is the treatment for gender dysphoria, and that, yes, it saves lives.

Because the bill bans the state from paying for any gender-affirming care, it would also result in forcible detransition for incarcerated trans people. The bill’s sponsor was very clear on that when another state representative asked. Further, the blanket prohibition on puberty blockers and hormone therapy would probably prohibit some treatments for stunted growth in children. Another legislator said that, as she read the bill, it may ban contraception for minors, although Fine said he didn’t think it would.

HB 1421 also prohibits any changes to birth certificates to reflect an adult’s gender identity. State Rep. Kelly Skidmore (D) had questions about why a bill supposedly aimed at “protecting” children would do that; Fine (again, not a doctor) explained that “your biology cannot be changed,” to which Skidmore replied, “Doctors would disagree. […] You can change your biology. That’s the point of gender-affirming care and surgery.”

Fine then muttered something about chromosomes, which kind of ignores the fact that hormone therapy very definitely changes a person’s biology, what with the differences in hair growth, body chemistry, and so on. But not chromosomes!

Fine went on to explain that gender-affirming care for minors is “child abuse,” although he acknowledged that’s his personal opinion, not actually a law. But co-sponsor Rep. Ralph Massullo — who somehow is a doctor — insisted it was just like “If you chop your sons arm off it’s child abuse,” so there’s a doctor who knows his stuff. Massullo also explained, contrary to the medical consensus, that since gender dysphoria is all in trans people’s heads, they should see a therapist and get cured through good old conversion therapy, which doesn’t work.

The most glaringly insane part of the bill is the former gambling executive’s medically muddy definition of “gender clinical interventions,” a term that isn’t actually from medicine. HB 1421 defines such interventions as

procedures or therapies that alter internal or external physical traits.

The term includes, but is not limited to:

1. Sex reassignment surgeries or any other surgical procedures that alter primary or secondary sexual characteristics.

2. Puberty blocking, hormone, and hormone antagonistic therapies.

The bill allows a few exceptions, such as for treatment of infants born with ambiguous genitalia, and of course for treatments to reverse gender-affirming care, but that’s about it; as House Democrats pointed out, the broad prohibitions on altering “primary or secondary sexual characteristics” appears to ban mastectomies, breast reduction or enhancement, maybe prostate surgery, and who knows, maybe even penile implants for treatment of erectile dysfunction.

But wait! Since it only applies to minors, Fine figured that wouldn’t be a problem. During questioning by state Rep. Christine Hunschofsky (D), Fine was surprised to hear that minors can even have breast cancer, though he remained skeptical of that anyway, and mocked what he said was the “pervasive problem of youth breast cancer.” Probably just an excuse to get top surgery, right sir?

Oh yes, and because it’s so sloppily written, the bill would also ban insurance from covering breast cancer mastectomies — for adults too, since the insurance ban is for all “gender clinical interventions,” regardless of the patient’s age.

Will Larkins, an 18-year-old high school student, testified against the bill, telling the committee members that his transgender friends would be directly harmed by the bill, not “protected.” He begged the lawmakers to at least agree to a Democratic amendment that would allow youth who have already begun treatment to continue it.

“That health care has saved their lives. You will kill them. I am telling you right now — look me in the eyes — you will kill them if you pass this bill and you don’t pass this amendment. […] You will kill them if you force them to detransition.”

The committee rejected the amendment, because there are no trans people in Florida, just punching bags to beat up on for the cameras.

This is where we wish we could tell you that HB 1421 is so obviously unconstitutional that there’s no chance it will pass and be signed into law, but you’ve been here for a while and you wouldn’t ever fall for a hopeful lie like that. We don’t even think they’d listen to our new hero, Grace Linn, that wonderful centenarian wonder woman. But who knows? Bet she’d make a trans lives matter quilt if she thought it would help.

[HuffPo / Florida HB 1421 / Erin Reed on Twitter / New Republic / Image generated by DreamStudio Lite AI]

Yr Wonkette is funded entirely by reader donations. If you can, please give $5 or $10 a month so we can keep you up to date on the horror show parts of our nation seem bent on becoming. We can’t let the bastards get away with this.

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Men with advanced prostate cancer going without life-prolonging medication amid shortage | CNN



CNN
 — 

Doctors across the United States who treat people with advanced prostate cancer can’t find supplies of a medicine that may help them live longer.

Pluvicto, a drug to treat metastatic castration-resistant prostate cancer, also known as mCRPC, is in such short supply that its maker, Novartis, said it cannot allow further supply to new patients until it can produce more of the drug. The company said it is working to produce enough doses to treat existing patients.

“We recognize that this situation is distressing for patients whether they are currently in the treatment process and being rescheduled, or waiting for their first dose of Pluvicto,” Novartis said in a statement to CNN. “Any interruption in the process, from unplanned manufacturing events to doses not arriving in time, may result in patient doses being rescheduled and can have a cascading effect on patients scheduled for future treatment.”

The Swiss company said it has been in touch with treatment centers and providers in the US and is “actively engaging with them to manage rescheduling of patient doses.”

The problem is that Novartis’ manufacturing facility in Ivrea, Italy, can’t keep up with demand for the drug. In May, it had to suspend production at the facility due to what it said was “an abundance of caution” related to potential quality issues. It also paused production at a New Jersey plant that makes the drug for the Canadian market.

Novartis resumed production at both plants in June.

The company hopes to get the New Jersey plant authorized to produce the drug for the US market, but it’s not clear when that might happen. Novartis said in early March that it had completed its filing for approval from the US Food and Drug Administration.

Someone who has a late-stage cancer that has spread to other parts of the body doesn’t have a lot of time to wait for the company to make more, doctors say, nor do they have many other treatment options. So even if Novartis got approval for the New Jersey plant quickly, the help will come too late for many people, according to Dr. Daniel Spratt, chair of the Department of Radiation Oncology at University Hospitals Seidman Cancer Center in Cleveland.

Novartis said it is prioritizing people who are currently being treated with Pluvicto, which is given in six cycles. But Spratt said the supply has recently been too low even for some of these patients.

“Many patients are missing months of therapy,” he said. “The real tragedy is the patients partially under treatment who have had great responses and we can’t get them the rest of their therapy in a timely fashion.”

Next to skin cancer, prostate cancer is the most common cancer in American men, according to the American Cancer Society. Most men do not die from prostate cancer, but about 34,700 people are expected to die from it this year. It’s the second leading cause of cancer death for American men, behind only lung cancer.

Pluvicto is a targeted radioligand therapy, meaning it uses radioactive atoms to deliver radiation to targeted cells, fighting cancer while limiting damage to the surrounding tissues.

There is no cure for this advanced stage of cancer, but Pluvicto can help people live longer. When the drug got FDA approval in March 2022, Spratt said, there was a lot of excitement about its potential. His patients who had heard about the trials have been asking about it for years.

One study from Novartis’ trials found that people who got the drug lived a median of about 15 months after diagnosis, four months longer than the median for people who didn’t get the treatment. For a handful of people, the recovery is even more dramatic.

“There are some patients that really do have those sort of miraculous responses, so it does occasionally give us one of those ‘wow’ moments,” said Dr. William Dahut, chief scientific officer at the American Cancer Society.

Dahut said doctors also like Pluvicto because, compared with other cancer treatments, it’s easy to administer and has relatively few side effects, other than dry mouth.

Another side effect of the shortage is that it’s slowing the progression of research. There is some indication that the drug could help people before their cancer reaches such a late stage.

“We’re anxious to have greater supply to study it in broader populations,” Dahut said.

Spratt said he is working closely with the medical oncologists in his health care system to try to find alternative treatment options, and he’s been looking to get people into clinical trials so they can get access to the therapy.

“But there’s really very few options available,” he said.

Novartis said that if the FDA approves its plant in Milburn, New Jersey, it could supply more Pluvicto as early as this summer.

The agency told CNN that it “is not able to discuss details regarding any possible communications or actions with companies due to commercial confidential information.”

“To be clear, FDA does not manufacture, produce, bottle, or ship drugs and cannot force companies to do so or make more of a drug. However, in general, the FDA works with firms making drugs in shortage to help them ramp up production if they are willing to do so. Often, they need new production lines approved or need new raw material sources approved to help increase supplies. FDA can and does expedite review of these to help resolve shortages of medically necessary drugs.”

Novartis is also building a plant in Indianapolis where the drug will be produced, but that won’t be up and running until the end of the year, the company said.

In the meantime, doctors will often have to tell their patients that they probably won’t be able to help get them this life-extending drug for some time.

“Some men and their physicians will feel that some hope was taken from them,” Spratt siad. “Cancer is the enemy here, not the company, but it’s unfortunate to have that excitement that your physician will be able to prescribe it to you and just not be able to give it to them.”

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Most men with prostate cancer can avoid or delay harsh treatments, long-term study confirms | CNN



CNN
 — 

Most men who are diagnosed with prostate cancer can delay or avoid harsh treatments without harming their chances of survival, according to new results from a long-running study in the United Kingdom.

Men in the study who partnered with their doctors to keep a close eye on their low- to intermediate-risk prostate tumors – a strategy called surveillance or active monitoring – slashed their risk of the life-altering complications such as incontinence and erectile dysfunction that can follow aggressive treatment for the disease, but they were no more likely to die of their cancers than men who had surgery to remove their prostate or who were treated with hormone blockers and radiation.

“The good news is that if you’re diagnosed with prostate cancer, don’t panic, and take your time to make a decision” about how to proceed, said lead study author Dr. Freddie Hamdy, professor of surgery and urology at the University of Oxford.

Other experts who were not involved in the research agreed that the study was reassuring for men who are diagnosed with prostate cancer and their doctors.

“When men are carefully evaluated and their risk assessed, you can delay or avoid treatment without missing the chance to cure in a large fraction of patients,” said Dr. Bruce Trock, a professor of urology, epidemiology and oncology at Johns Hopkins University.

The findings do not apply to men who have prostate cancers that are scored through testing to be high-risk and high-grade. These aggressive cancers, which account for about 15% of all prostate cancer diagnoses, still need prompt treatment, Hamdy said.

For others, however, the study adds to a growing body of evidence showing that surveillance of prostate cancers is often the right thing to do.

“What I take away from this is the safety of doing active monitoring in patients,” said Dr. Samuel Haywood, a urologic oncologist at the Cleveland Clinic in Ohio, who reviewed the study, but was not involved in the research.

Results from the study were presented on Saturday at the European Association of Urology annual conference in Milan, Italy. Two studies on the data were also published in the New England Journal of Medicine and a companion journal, NEJM Evidence.

Prostate cancer is the second most common cancer in men in the United States, behind non-melanoma skin cancers. About 11% – or 1 in 9 – American men will be diagnosed with prostate cancer in their lifetime, and overall, about 2.5% – or 1 in 41 – will die from it, according to the National Cancer Institute. About $10 billion is spent treating prostate cancer in the US each year.

Most prostate cancers grow very slowly. It typically takes at least 10 years for a tumor confined to the prostate to cause significant symptoms.

The study, which has been running for more than two decades, confirms what many doctors and researchers have come to realize in the interim: The majority of prostate cancers picked up by blood tests that measure levels of a protein called prostate-specific antigen, or PSA, will not harm men during their lifetimes and don’t require treatment.

Dr. Oliver Sartor, medical director of the Tulane Cancer Center, said men should understand that a lot has changed over time, and doctors have refined their approach to diagnosis since the study began in 1999.

“I wanted to make clear that the way these patients are screened and biopsied and randomized is very, very different than how these same patients might be screened, biopsied and randomized today,” said Sartor, who wrote an editorial on the study but was not involved in the research.

He says the men included in the study were in the earliest stages of their cancer and were mostly low-risk.

Now, he says, doctors have more tools, including MRI imaging and genetic tests that can help guide treatment and minimize overdiagnosis.

The study authors say that to assuage concerns that their results might not be relevant to people today, they re-evaluated their patients using modern methods for grading prostate cancers. By those standards, about one-third of their patients would have intermediate or high-risk disease, something that didn’t change the conclusions.

When the study began in 1999, routine PSA screening for men was the norm. Many doctors encouraged annual PSA tests for their male patients over age 50.

PSA tests are sensitive but not specific. Cancer can raise PSA levels, but so can things like infections, sexual activity and even riding a bicycle. Elevated PSA tests require more evaluation, which can include imaging and biopsies to determine the cause. Most of the time, all that followup just isn’t worth it.

“It is generally thought that only about 30% of the individuals with an elevated PSA will actually have cancer, and of those that do have cancer, the majority don’t need to be treated,” Sartor said.

Over the years, studies and modeling have shown that using regular PSA tests to screen for prostate cancer can do more harm than good.

By some estimates, as many as 84% of men with prostate cancer identified through routine screening do not benefit from having their cancers detected because their cancer would not be fatal before they died of other causes.

Other studies have estimated about 1 to 2 in every five men diagnosed with prostate cancer is overtreated. The harms of overtreatment for prostate cancer are well-documented and include incontinence, erectile dysfunction and loss of sexual potency, as well as anxiety and depression.

In 2012, the influential US Preventive Services Task Force advised healthy men not to get PSA tests as part of their regular checkups, saying the harms of screening outweighed its benefits.

Now, the task force opts for a more individualized approach, saying men between the ages of 55 and 69 should make the decision to undergo periodic PSA testing after carefully weighing the risks and benefits with their doctor. They recommend against PSA-based screening for men over the age of 70.

The American Cancer Society endorses much the same approach, recommending that men at average risk have a conversation with their doctor about the risks and benefits beginning at age 50.

The trial has been following more than 1,600 men who were diagnosed with prostate cancer in the UK between 1999 and 2009. All the men had cancers that had not metastasized, or spread to other parts of their bodies.

When they joined, the men were randomly assigned to one of three groups: active monitoring or using regular blood tests to keep an eye on their PSA levels; radiotherapy, which used hormone-blockers and radiation to shrink tumors; and prostatectomy, or surgery to remove the prostate.

Men who were assigned monitoring could change groups during the study if their cancers progressed to the point that they needed more aggressive treatment.

Most of the men have been followed for around 15 years now, and for the most recent data analysis, researchers were able get follow-up information on 98% of the participants.

By 2020, 45 men – about 3% of the participants – had died of prostate cancer. There were no significant differences in prostate cancer deaths between the three groups.

Men in the active monitoring group were more likely to have their cancer progress and more likely to have it spread compared with the other groups. About 9% of men in the active monitoring group saw their cancer metastasize, compared with 5% in the two other groups.

Trock points out that even though it didn’t affect their overall survival, a spreading cancer isn’t an insignificant outcome. It can be painful and may require aggressive treatments to manage at that stage.

Active surveillance did have important benefits over surgery or radiation.

As they followed the men over 12 years, the researchers found that 1 in 4 to 1 in 5 of those who had prostate surgery needed to wear at least one pad a day to guard against urine leaks. That rate was twice as high as the other groups, said Dr. Jenny Donovan of the University of Bristol, who led the study on patient-reported outcomes after treatment.

Sexual function was affected, too. It’s natural for sexual function to decline in men with age, so by the end of the study, nearly all the men reported low sexual function, but their patterns of decline were different depending on their prostate cancer treatment, she said.

“The men who have surgery have low sexual function early on, and that continues. The men in the radiotherapy group see their sexual function drop, then have some recovery, but then their sexual function declines, and the active monitoring group declines slowly over time,” Donovan said.

Donovan said that when she presents her data to doctors, they point out how much has changed since the study started.

“Some people would say, ‘OK, yeah, but we’ve got all these new technologies now, new treatments,’ ” she said, such as intensity-modulated radiation therapy, brachytherapy and robot-assisted prostate surgeries, “but actually, other studies have shown that the effects on these functional outcomes are very similar to the effects that we see our study,” she said.

Both Donovan and Hamby feel the study’s conclusions still merit careful consideration by men and their doctors as they weigh treatment decisions.

“What we hope that clinicians will do is use these figures that we’ve produced in these papers and share them with the men so that newly diagnosed men with localized prostate cancer can really assess those tradeoffs,” Donovan said.

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Cancer screenings could be back to normal after millions missed during Covid-19 pandemic | CNN



CNN
 — 

Millions of people across the United States missed routine cancer screenings during the second year of the Covid-19 pandemic, with the prevalence of screening for breast, cervical and prostate cancers in the previous year falling anywhere from 6% to 15% between 2019 and 2021, according to a new study from the American Cancer Society.

“We were thinking there would be a rebound in late 2020,” said Dr. William Dahut, chief scientific officer of the American Cancer Society. “We were surprised to see the continued increase in the number of folks not getting their screenings.”

But more recently, it appears that people are starting to return to routine screenings at rates seen before the pandemic, separate research suggests.

Rates of screening for breast, cervical and colon cancers may have returned to normal, according to more recent data published last week in the journal Epic Research, which is owned by the health care software company Epic.

“As screening rates returned to normal from the drop we previously reported, rates of cancer diagnosis returned to normal as well,” Dr. Chris Alban, a clinical informaticist at Epic Research, wrote in an email.

“We haven’t seen evidence that the screenings missed during the pandemic resulted in worsened patient outcomes, though we plan to monitor this trend to see whether it holds over time,” he said. “The recommended intervals between screenings for a given cancer can be several years, so evidence of advanced cancers can take a long time to appear.”

Due to the declines in cancer screenings as well as barriers to accessing treatment in the early days of the pandemic, not only did physicians nationwide worry that screening and treatment delays led to patients arriving at their offices with advanced cancer, some anecdotally reported seeing upticks in advanced cancers at the time.

The prevalence of screening for breast, cervical and prostate cancers did not return to pre-pandemic levels in 2021, the second year of the Covid-19 pandemic, according to the American Cancer Society’s new study, published Thursday in the Journal of Clinical Oncology.

The study included data on more than 60,000 adults in the United States who were eligible for screening for breast, cervical, prostate and colorectal cancers between 2019 and 2021. The data came from the US Centers for Disease Control and Prevention’s National Health Interview Survey.

The researchers found that between 2019 and 2021, the overall prevalence of eligible adults who completed screening in the previous year fell 6% for breast cancer, 15% for cervical cancer and 10% for prostate cancer. That means there were about 1 million fewer people who got screened for breast cancer, 4.4 million fewer screened for cervical cancer and about 700,000 fewer screened for prostate cancer.

“These declines have significant public health implications as they are expected to lead to more advanced stage cancer diagnosis in the future,” the researchers wrote.

The prevalence of screening for colorectal cancer was unchanged, the researchers found.

The growing popularity of at-home colon cancer screening tests probably offset any decline in colorectal cancer screenings, they wrote.

The researchers also found some racial differences, as the Asian community had the largest declines in breast, cervical and prostate cancer screenings.

“These findings are especially concerning as cancer is the leading cause of death in both Asian American men and women,” wrote the researchers, all from the American Cancer Society.

Dahut said that anyone who missed a routine cancer screening during the early days of the pandemic should catch up now.

“Even in the best of times, the number of folks who are screened is far too low,” he said. “Go ahead and follow the guidelines, get screened when appropriate, and the outcomes will be better.”

The Epic Research study involved data on 373,574 cancer diagnoses entered in patients’ charts in the US between January 2018 and December 2022.

The data came from 190 health care organizations that use software from Epic for their electronic health records. Together, these organizations represent 1,123 hospitals and more than 22,500 clinics, and they agreed to contribute to the de-identified data set, meaning no individual patient can be identified within the data.

The data showed a clear decrease in cancer cases early in the pandemic, which correlates with a decline in screening, but screening rates appeared to return to normal last year, as did cancer detection rates. The data also did not appear to show a significant rise in new diagnoses of advanced cancers through the end of last year.

It’s “good news” that the data demonstrate a return to pre-Covid rates of cancer screening, Dr. Arif Kamal, the American Cancer Society’s chief patient officer – who was not involved in the Epic Research study – wrote in an email. He called the new data intriguing but emphasized that more time is needed to determine whether or when rates of advanced cancers may increase due to missed screenings. It could take years.

“Conclusions regarding whether advanced cancer rates have increased due to missed screenings are a bit premature to reach. This is because cancer takes years to develop, and the resulting effect of missed cancers cannot be known after only a few years,” Kamal said.

“We remain hopeful that as cancer screening rates have returned to baseline, that the two years of missed screenings will not have a long-lasting effect on cancer incident or mortality,” he said. “But more time will tell.”

The data from Epic Research’s study is encouraging, as it suggests that more advanced cancers are not being seen, Dr. David Cohn, chief medical officer for the Ohio State University Comprehensive Cancer Center, wrote in an email.

“Whether this holds up over the next few years is yet to be seen,” he added.

Cohn, a practicing gynecologic oncologist who was not involved in either new study, said that he is “always concerned” about a decrease in screening rates and the resulting impact on later cancer diagnoses.

Yet “these data suggest that folks are getting back to the core business of screening,” he said, “such that these data will hopefully hold up over the next few years without seeing an increase in later diagnoses.”

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U.S. Cancer Deaths Decline Overall, But Prostate Cancers Make Rebound

By Dennis Thompson 

HealthDay Reporter

THURSDAY, Jan. 12, 2023 (HealthDay News) — Cancer deaths continue to decline, dropping 33% since 1991 and saving an estimated 3.8 million lives, according to the American Cancer Society’s annual statistics report.

But individual trends within that overall success story highlight the struggle to find the best ways to prevent, detect and treat cancer for all Americans, the society said.

On the positive side, the United States saw an “astounding” 65% reduction in cervical cancer rates among 20- to 24-year-old women between 2012 and 2019, a direct result of human papillomavirus (HPV) vaccination, said Dr. William Dahut, chief scientific officer at the American Cancer Society (ACS).

“The effort that our children went through over the last 20 years or so to go through vaccinations have actually saved lives,” Dahut said, noting that the plummeting case level “totally follows the time when HPV vaccines were produced.”

Chief executive officer Karen Knudsen added that “this is some of the first real-world evidence that HPV vaccination is likely to be effective in reducing cancer incidence and [death rates].”

Unfortunately, rates of advanced prostate cancers are on the rise, likely driven by confusion and conflict over screening guidelines, ACS officials said.

The second-leading cause of cancer death for U.S. men, prostate cancer cases rose 3% a year from 2014 through 2019 after two decades of decline, the report found.

There’s also been a 5% year-over-year increase in diagnosis of men with advanced prostate cancer, “so we are not catching these cancers early, when we have an opportunity to cure men,” Knudsen said.

Black men, in particular, are being affected by the rise in prostate cancer, according to the report.

“Black men, unfortunately, have a 70% increase in incidence of prostate cancer compared to white men and a two- to fourfold increase in prostate cancer [death rates] as related to any other ethnic group in the United States,” Knudsen said.

The nation’s leading authority on health screening, the U.S. Preventive Services Task Force, recommends that men between 55 and 69 years of age discuss the potential benefits and harms of prostate cancer screening with their doctor and then decide for themselves.

American Cancer Society guidelines recommend that doctors discuss screening with men at an earlier age — 40 for those with a close relative who has had prostate cancer, 45 for men at high risk, and 50 for nearly all others.

The concern is that the screening tool — the blood-based PSA (prostate-specific antigen) test — can be influenced by factors other than prostate cancer, Knudsen said. For example, inflammation of the prostate can cause a rise in PSA.

Men who undergo prostate cancer surgery or radiation therapy can wind up with lifelong side effects like impotence or incontinence. Because of this, screening guidelines have tended to be conservative.

But the science around prostate cancer detection has advanced in recent years, Dahut said.

Doctors can now put together a genetic profile that will reveal increased risk in some men. For instance, the BRCA2 gene normally associated with breast cancer “puts people at higher risk for having more aggressive prostate cancer,” Dahut said.

Imaging tools also have improved.

“MRI imaging of the prostate has really dramatically changed the way we think of actually determining if prostate cancer is likely to be there and how to go ahead and biopsy it,” Dahut said. “And there may be ways to do relatively rapid MRIs. They’re doing that actually in the U.K. right now.”

Combining family history, genetic risk factors and MRI results can help doctors weed out potential prostate cancers from cases where PSA levels have increased for other reasons, Dahut said.

Knudsen agreed.

“This is not the 1990s, where a rising PSA would trigger potentially premature strategies for prostate removal,” she said. “We have moved so far beyond that as a field.”

To address these prostate cancer trends, the ACS is launching the IMPACT initiative — Improving Mortality from Prostate Cancer Together.

It’s aimed at reversing the disparities in prostate cancer for Black men and reducing death rates overall by 2035, Knudsen said.

IMPACT will include new research programs, improved education efforts and a reconsideration of prostate cancer screening guidelines, she explained.

“With prostate cancer still sitting as the second-leading cause of cancer death, and that shift toward a diagnosis of more aggressive disease, we can no longer stand back and not act,” Knudsen said.

The Cancer Statistics 2023 report contained other pieces of good news, including an all-time high 12% five-year survival rate for pancreatic cancer, up 1 percentage point from the previous year.

This is the first time since 2017 that the survival rate for pancreatic cancer has increased two consecutive years, the Pancreatic Cancer Action Network noted in a statement.

There’s no standard early detection method for pancreatic cancer, which often only has vague symptoms. The disease is typically diagnosed late, once it has already spread.

“For a disease as difficult as pancreatic cancer, an annual increase of 1 percentage point is an important and encouraging milestone that shows we’re headed in the right direction and our comprehensive approach is working,” said Julie Fleshman, president and CEO of the network. “But 12% is still the lowest five-year survival rate of all major cancers so we need to build on this momentum by continuing to fund research to find an early detection strategy and better treatment options for pancreatic cancer patients.”

The findings were published online Jan. 12 in CA: A Cancer Journal For Clinicians.

More information

The American Cancer Society has more about cancer facts and statistics.

 

SOURCES: William Dahut, MD, chief scientific officer, American Cancer Society, Atlanta; Karen Knudsen, MBA, PhD, chief executive officer, American Cancer Society, Atlanta; Julie Fleshman, MBA, JD, president and chief executive officer, Pancreatic Cancer Action Network, El Segundo, Calif.; CA: A Cancer Journal For Clinicians, Jan. 12, 2023, online

 

 

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