Prostate cancer is not a death knell, study shows

(Press-News.org) Prostate cancer statistics can look scary: 34,250 U.S. deaths in 2024. 1.4 million new cases worldwide in 2022.  

Dr. Bruce Montgomery, a UW Medicine oncologist, hopes that patients won’t see these numbers and just throw up their hands in fear or resignation.  

“Being diagnosed with prostate cancer is not a death knell,” said Montgomery, senior author of a literature and trial review that appeared in JAMA today. Montgomery is the clinical director of Genitourinary Oncology at Fred Hutch Cancer Center and University of Washington Medical Center, and a professor of medicine and urology at the UW School of Medicine.  

He encourages patients to ask their primary-care doctor specific questions about this cancer too.  Montgomery also encourages his fellow doctors to bring up the question of prostate cancer screening with their patients. 

“Knowing whether there is prostate cancer and how risky it is can be the first step. Not every cancer needs to be treated,” he said. “Sometimes it’s safe to just watch and use active surveillance.”   

A 2024 study coauthored by UW Medicine urologist Dr. Daniel Lin showed that active surveillance can be extremely safe: 0.1% of men who opted for surveillance died of prostate cancer after 10 years.  

“We need to realize that prostate cancer is not one disease,” Montgomery said. “As a provider, you need to personalize your approach to the patient you’re seeing and to the disease that they personally are dealing with.” 

For example, if a 50-year-old man develops prostate cancer that is only in the prostate, then more aggressive measures may need to be considered. However, if the disease, which can be slow-moving, develops in an 80-year-old patient, the discussion may be quite different. 

“I’ve seen men that age (80s) develop prostate cancer and they’ve opted for no therapy,” he said. “They know that treatment, such as radiation, might make them feel terrible ... so they just say ‘no.’ 

You, as their physician, he noted, must respect that.  

“But if you’re 50 and have 25 to 30 years in which prostate cancer can become a bigger issue, even with the downsides, most patients should get therapy,” he said.  

For more advanced prostate cancer, the number of effective treatments developed has markedly increased, as has the survival rate of men with whose prostate cancer has spread to other parts of their bodies.  

 “Metastatic prostate cancer needs therapy and research over the past 10 to 20 years has improved and continues to improve survival substantially,” he said. “Knowing who needs treatment, which treatment to use and when is both an art and a science.” 
 

The article covered facts that men and their doctors should know, including: 

Approximately 1.5 million new cases of prostate cancer are diagnosed annually worldwide. Approximately 75% of cases are first detected when the cancer is still localized to the prostate. This early detection was associated with a five-year survival rate of nearly 100%.    Management includes active surveillance, prostatectomy surgical removal of the prostate, or radiation therapy, depending on risk of progression.  Approximately 10% of cases are diagnosed after the cancer has spread. This stage of prostate cancer   has a five-year survival rate of 37%.    The most common prostate cancer is adenocarcinoma, a type that starts in gland cells, and the median age at diagnosis is 67 years.   More than 50% of prostate cancer risk is attributable to genetic factors and older age.   Prostate cancer came to public attention, both nationally and internationally last year, when famed local travel writer, Rick Steves, announced he had developed prostate cancer. He proclaimed last month via his X account, formerly Twitter, that after radiation and surgery at UW Medicine and Fred Hutch, he was cancer free. 

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