The Lancet Commission on The Future of Prostate Cancer
The Lancet Commission is an independent medical journal that, since its inception in 1823, has sought to disseminate scientific information and analysis on a broader scale in the pursuit of a healthier international community. At the beginning of April, 2024, the commission produced and published a comprehensive, strategic exploration on the global state of prostate cancer in the coming decades. Interestingly, the commission takes a holistic approach to prostate cancer diagnosis, treatment, and education, asserting that, “as the rise in prostate cancer is likely to be mirrored by rises in other conditions such as diabetes and heart disease, early diagnosis programmes should focus not just on prostate cancer but on men’s health more broadly” (James et al., 2024, p. 1).
The commission recognizes both the pervasiveness and severity of prostate cancer on a global scale, projecting that, “the number of new cases will double between 2020-2040,” a troubling conclusion that we in the men’s health sphere recognize as being indicative of a larger issue: a general disregard for understanding men’s health, as well as the necessity to view prostate cancer through a gendered, recontextualized framework (James et al., 2024, p. 8).
The Lancet Commission acknowledges the unique conditions and clinical pathways observed in HIC’s (high-income countries) and how implementation of diagnostic tools and treatment differ profoundly in LMIC’s (low or middle income countries). The article states, “in HICs, for non-metastatic disease, the emphasis should be on reducing overtreatment in low-risk disease and reducing the treatment burden in higher-risk disease,” by outlining methods such as active surveillance, watchful waiting, informed choice-based testing, expansion of access, and “empowerment of patients,” via targeted circulation of educational materials and medical literature (James et al., 2024, p. 19). However, the global proliferation of prostate cancer cases, “are set to increase substantially in LMICs with little or no increase in most HICs,” so much of the necessary resources, policy recommendations, and education campaigns should focus primarily on these low and middle income countries (James et al., 2024, p. 15).
According to the commission’s findings: “in LMICs, too many men present with advanced disease—a major societal problem causing suffering, early death, and financial hardship for families” (James et al., 2024, p. 13). But to what extent, and through what means, can this suffering be mitigated? Prostate cancer, as is the case with many forms of cancer, cannot exactly be prevented. The commission recognizes this unfortunate reality, opting to articulate the essential role that early diagnosis plays in harm reduction. And one of the best ways to facilitate a collective pattern of early diagnosis is by conducting outreach via educational campaigns, increasing active patient engagement, and promoting general public awareness.
Many LMIC’s, for example, have a proclivity toward medical hesitancy and a bias for alternative, less effectual treatments: “studies of public awareness of prostate cancer in a range of countries in Sub Saharan Africa suggest widespread misconceptions about prostate cancer symptoms and treatment, coupled with reliance on traditional healers and taboos around discussing diagnoses” (James et al., 2024, p. 29). This proliferation of disinformation, however, is not particular to LMIC’s. The commission also expresses concern regarding “false or inaccurate information” that also “circulates in HICs, including on YouTube” and other social channels (James et al., 2024, p. 29).
The amplification of such disinformation and related sentiments of anti-intellectualism and medical distrust could forebode the potential for a backsliding quality in prostate cancer diagnostics and treatment, even in HIC’s where access to quality care is more broadly available. Moreover, growing medical distrust, though misguided, is not completely baseless or even justified.
The lifespan gender-gap is a reality that we, as men’s health advocates, healthcare providers, and patients alike, desperately need to address. The disparity in life expectancy between U.S men and women is now at its most substantial since the mid 1990s; it is estimated that women live approximately 6 years longer than men on average. While some projections profess that this disparity will begin to decrease globally, the lifespan gap has persisted for decades in almost every country.
The life expectancy gap between men and women is often attributed to men’s tendency to neglect their physical and mental well-being, as well as their higher participation in risk-associated behaviors such as smoking. There is certainly some truth to this explanation, but there is also a glaring disparity in both popular discourse and policy solutions regarding women’s and men’s health.
In order to popularize and publicize this model of men’s health, as was discussed previously, outreach designed particularly for men needs to be conducted on a global scale.
