New study shows nationwide increase in metastatic and aggressive prostate cancer

A new Dartmouth Cancer Center (DCC) study published in the American Journal of Clinical Oncology spanning nearly two decades of data shows that more men in the United States are being diagnosed with advanced and aggressive forms of prostate cancer.

The study was led by DCC clinical researcher and radiation oncologist James B. Yu, MD, MHS, whose motivation for it stemmed from what he was seeing in his own clinical practice. “I was noticing in my practice that patients were presenting with higher risk prostate cancer,” says Yu. At the same time, he noticed patients were not being screened as early as they had been when he began working in radiation oncology in the 2000s.

These observations led him to ask, “How much of the higher risk prostate cancer at presentation was due to a lack of screening and how much of it was due to intrinsic changes in prostate cancer itself?”

To explore this question, Yu and his research colleagues examined national cancer data trends in prostate cancer diagnosed between 2004 and 2022. Some of their findings showed:

• Higher PSA levels: The percentage of patients presenting with elevated prostate-specific antigen (PSA) dropped until 2009, but has been rising since. 
• More aggressive tumors: Diagnoses of high-grade, fast-growing prostate cancer increased from 2008 to 2015 before leveling off. 
• Spreading disease: Cases of metastatic prostate cancer have been steadily increasing since around 2007.
• Higher-risk genetics: Tumor genetic testing scores showed a rise in higher-risk disease features over time.

While modern technology, like improved MRI scans and precise biopsies, helps catch high-risk tumors earlier, Yu believes there are other factors at play. “We are getting better at detecting high-risk disease, but also, there is something happening epidemiologically that is promoting more aggressive prostate cancers in men across the U.S.”

While Yu’s findings take an important step toward recognizing disease trends, more study is needed to understand and address what may be driving them. He hopes future research will explore screening and access to advanced prostate imaging and biopsy, as well as obesity, diet, and other environmental and lifestyle factors.