Biden's diagnosis highlights little-noticed rise in late-stage prostate cancers
Outdated controversy over PSA tests may be a cause of increase, experts say
The cancer diagnosis former President Joe Biden received was difficult — stage 4 prostate cancer — but has become more and more common in recent years. This trendline, cancer experts said, is not widely known, even among physicians, and points to a need to dispel myths about prostate cancer screening.
If caught early, prostate cancer can have very good outcomes — the 5-year relative survival rate at earlier stages is almost 100%. In the metastatic setting, that drops to 37%. Current guidelines recommend that men from the ages of 55 to 69 have a discussion with their provider about screening, which can prevent advanced prostate cancer. Still, that rise in late-stage diagnoses seems to have continued through the last decade and a half.
Experts said that might be due to the fact that prostate cancer screening had once been mired in controversy around whether it caused more harm than benefit. That may have led to a drop in prostate screening years ago that could be resulting in a rise in metastatic disease today, even though experts no longer debate the benefit of prostate screening.
“In the last 10 years, there was this uncertainty, and people landed on one side or the other,” said Ruth Etzioni, a cancer researcher and biostatistician who studies cancer screening at the Fred Hutchinson Cancer Center. “Today, the message needs to get out that, done properly, this is a beneficial intervention, and we all basically agree on this.”
“It’s huge for cancer. We don’t see cancer rates changing that fast very often. A lot of people have hypothesized it reflects changing the PSA screening guidelines,” said Erin Van Blarigan, an epidemiologist and cancer researcher at UCSF and the lead author on the JAMA paper. “The change we observe really started in 2011 to 2014.”
That was around the time the prostate cancer screening test, called the PSA or prostate specific antigen test, started to fall out of favor. The landmark trial that studied the effectiveness of the PSA test was called the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, and it showed in 2009 that men who were assigned to PSA testing didn’t experience any mortality benefit compared to men who weren’t assigned to PSA testing. That kickstarted the controversy around PSA testing, and also ultimately led the United States Preventive Services Task Force to downgrade the test’s recommendation in 2012.
https://www.statnews.com/2025/05/21/biden-cancer-part-of-worrisome-trend-rise-in-late-stage-prostate-cancer-diagnoses/
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