June is Men’s Health Awareness month, a time that serves as an opportunity to reflect on men’s health issues. Unfortunately, one concerning trend is an increase in advanced stages of prostate cancer in men.

Prostate cancer is one of the top causes of death in men in the United States, the cause of death related to cancer second only to lung cancer. The American Cancer Society (ACS) reports that there are currently more than three million men in the country living with a prostate cancer diagnosis. The ACS expects 299,010 new cases and over 35,000 deaths due to prostate cancer in 2024 alone. When medical professionals do not diagnose cancer early, it has time to spread and can become more difficult to treat. This can cause patients to suffer unnecessary physical pain, emotional anguish, and even death.

PSA Testing

Prostate specific antigen is a test that is able to show inflammation and cancer changes in the prostate. Unfortunately values for prostate cancer are somewhat arbitrary, and the currently considered upper limit of normal for PSA of 4 misses a substantial number of early cancers. Studies have shown that men with a PSA between 2.5 and 10 have a 15% chance of having prostate cancer. This means that there would be six negative biopsies for every one positive biopsy, and patients must make an individual choice as to whether it’s worth the risk, trauma and anxiety to have a biopsy. On the other hand, serial PSA testing can be helpful to detect developing prostate cancer if the relative rise in PSA values is abnormal. This means that an informed discussion by the physician with the patient is necessary so each man can make an individualized choice about how to screen for prostate cancer.

What are the risks of delayed treatment for prostate cancer?

When a doctor misdiagnoses or delays a prostate cancer diagnosis, patients face several significant risks that can include:

• Reduced Survival: A delayed diagnosis of prostate cancer significantly reduces the odds of survivability. Once the prostate cancer spreads outside the capsule, management rather than cure is the only option.
• Physical pain and aggressive treatment: Early prostate cancer can be cured with radical prostatectomy and sometimes radiation. Later stage prostate cancer is treated with hormone therapy, radiation and chemotherapy.
• Grief: The emotional toll of a missed diagnosis can be devastating for patients and their It is important for the medical team to keep the emotional well-being a priority when managing prostate cancer care.
• Negative impact to sexual function: Depending on the patient’s choice of treatment, sexual and

urinary function may be negatively affected. Patients who choose prostatectomy for early prostate cancer will likely suffer some incontinence and reduced sexual potency, but a cure is achievable. Those who choose radiation are less likely to have these complications but must continue to monitor PSA for recurrence.,

• Scarring and organ removal: Surgical interventions may result in scarring and the removal of vital organs. Radiation can cause internal scarring that can lead to abdominal and urinary problems.

In extreme cases, delayed diagnosis increases the risk of metastasis and prostate cancer-related mortality.

How has the medical community responded to this data?

The issue dates back decades. In the early 2000s, there was concern that the medical community was overreacting to prostate cancer diagnosis. The thought was that many of these older males diagnosed with a slow-moving form of prostate cancer would die of other conditions before the prostate cancer became worrisome. As such, it was not logical to put the patient through the adverse effects that can come with treatment.

As a result of this line of thinking, the United States Preventive Services Task Force (USPSTF) recommended that physicians reduce prostate cancer screening practices. In 2012, the USPSTF advised against any routine screening. This recommendation evolved and now requires that physicians have an informed discussion with the patient about the benefits and risks of PSA screening. Each man should make a personalized decision. This lack of clear guidance about screening has likely played a role in the current increased incidence of advanced prostate cancer diagnosis. Medical professionals are reviewing this information and recommending an increase in screening and a more nuanced approach to treatment of slow-growing cancers.

What are my options if I or a man I love is injured due to delayed treatment?

We hold our medical professionals to high standards. We expect them to provide quality care. Legal remedies are often available if we or those we love are injured due to a medical team’s failure to meet this expectation.