Why Are So Many People Misinterpreting the ACS Prostate Cancer Data?

Numbers

Since the American Cancer Society (ACS) released their annual Cancer Facts & Figures report for 2020, there’s been a lot of commentary on the internet about prostate cancer death rates. Some of the loudest voices are howling that the prostate cancer problem is getting worse. The Prostate Cancer Foundation would like to take a moment to unpack this profound oversimplification of the results. Here’s a 7-point primer on the facts and myths being circulated around the report.

Before we even begin, we want to remind everyone that these kind of large-scale examinations of cancer data look backward into the past. That means that the information published this year is an estimate, based on what happened 3 or 4 years ago. In other words, the ACS report released in 2020 covers events that occurred between the years 2002-2016 (new cases) and 2003-2017 (deaths).

Claim 1: More men will die of prostate cancer in 2020 than in 2019.
Answer: Maybe.

ACS estimates that the number of deaths from prostate cancer will be 33,330 in 2020; that’s up from 31,620 in 2019. So, clearly, prostate cancer deaths went up, right? Not so fast. As stated above, these numbers are still just estimates. Even though it’s 2020, we don’t know how many men actually died of prostate cancer in 2019. As a matter of fact, the last year we know how many men actually died of prostate cancer is 2017. At the Prostate Cancer Foundation, we believe every life counts, and we won’t stop until we end ALL death and suffering from prostate cancer, but looking at estimated deaths in a single year doesn’t tell the full story. Read on…

Claim 2: More men will be diagnosed with prostate cancer in 2020 than 2019.
Answer: Maybe.

The number of estimated cases rose from 174,650 to 191,930, right? The key word here and above is estimated: because this data is modeled (meaning projected by a computer) as opposed to actual, ACS clearly states in their report (page 68) that this data cannot be used to track trends from year to year. Even if diagnosis (also known as incidence) were on the rise, it’s possible there’s a hidden silver lining in this number. As awareness of the disease increases, more cases are being discovered, and they are being discovered earlier and are more curable. Campaigns like Light it Blue for Prostate Cancer Awareness Month and resources like the Prostate Cancer Patient Guide help more men know their risks and get on the proper treatment path earlier. And if there’s one thing we know with prostate cancer: early detection saves lives.

Claim 3: The death rate from prostate cancer went up.
Answer: False

Here’s where the rubber meets the road. Even though the absolute numbers of estimated diagnoses and deaths went up, the actual rate of death from prostate cancer – that is, how many U.S men died of prostate cancer per 100,000 men alive in the U.S. – went down, from 19.4 in 2016 to 18.8 per 100,000 in 2017. Death rates fall as more patients are cured or cancers are prevented – or both. This suggests to many public health experts that in part thanks to PSA screening, more men caught their disease at an earlier stage, when it is more likely to be treatable, and that new treatments are more effective in allowing men to live longer free from death due to prostate cancer.

Claim 4: The decline in death rate over the last 25 years for prostate cancer is 52%. That is one of the biggest declines among the top 10 U.S. cancers.
Answer: True

Since 1993 when PCF was founded, we have seen an overall decline in death rate (actual deaths from prostate cancer per 100,000 men). In that time, PCF has funded nearly every practice-changing development in the field, including early investment in 11 life-saving or life-extending drugs in oncology.

Claim 5: The decline in death rate for prostate cancer has bottomed out.
Answer: That is complicated.

Between 2016-2017, the death rate declined slightly. But for the previous period in time, it increased, leaving us with a net decline of almost zero over the last two-year period reported (-0.1%). Why might this be? Here’s one thought: Baby Boomers, a sizably larger generation than the one before it, are coming of age for cancer. It’s a numbers game: volume alone will account for more cases and deaths. We’re finding more cases, but we are also curing more cases. It’s not a simple equation… but that doesn’t mean we aren’t working to solve it.

Claim 6: We should be very very scared right now.
Answer: False

Remember, these numbers are 3 years in arrears. In just the last three years since the period covered by this report, we have seen some amazing progress, including multiple new FDA-approved treatments for advanced and metastatic disease, development of novel imaging technologies that can better pinpoint the location and extent of disease, and tremendous strides in understanding the genetic drivers of prostate cancer that will allow for precision screening and treatment. This is a very hopeful time for men with prostate cancer. That said, PCF is committed to relentlessly and aggressively fighting this disease until no family is made to suffer.

Claim 7: The Prostate Cancer Foundation is funding the most cutting-edge, promising research to end death and suffering from prostate cancer.
Answer: True

Learn more at impact.pcf.org

Becky Campbell
Becky Campbell develops medical content at the Prostate Cancer Foundation. She has previously worked in outcomes research and in science education.