Should Older Men Be Screened for Prostate Cancer?

Screening for prostate cancer in older men has been problematic. While this form of cancer can be fatal, it often progresses so slowly that men are more likely to die from some other disease. Aggressive treatments such as radical prostatectomy or radiation therapy may eradicate the cancer but have negative effects on quality of life. More conservative treatments may preserve quality of life, but may not be appropriate for those cases where the disease is progressing more quickly. In the face of these uncertainties, what is the appropriate age to stop screening?

Although guidelines suggest that men 75 years or older may not benefit from screening, surveys continue to show high rates of screening in this population. Since most screening and treatment trials for prostate cancer have systematically excluded older men, there are no well-characterized data about survival and quality-of-life issues.

In a population-based cohort study published in the May issue of The American Journal of Medicine, researchers followed 465 men aged 75 to 84 who had been diagnosed with clinically localized prostate cancer in 1994 or 1995. Of those patients, 175 received aggressive treatment (surgery or radiation therapy) and 290 received hormone therapy or no treatment. The authors evaluated health-related quality of life (HRQOL) outcomes and survival 2 years after the original diagnosis. Survival was also evaluated 7 years after diagnosis.

Writing in the article, Richard M. Hoffman, MD, MPH, of the Medicine Service, New Mexico VA Health Care System and the University of New Mexico Cancer Research and Treatment Center, concludes, “Aggressive treatment minimally reduced the risk of dying from prostate cancer; disease specific survival, however, was relatively high in both groups because most deaths were from other causes. However, by 24 months following diagnosis, men who received aggressive treatment had suffered more urinary and bowel dysfunction and were more bothered by sexual dysfunction. General health and physical function were higher for aggressively treated men but this was likely due to residual selection bias. Our results reinforce concerns that men 75 years and older may not benefit from prostate cancer screening because they may suffer adverse outcomes from aggressive treatment of localized disease.”

The article, “Health Outcomes in Older Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study” by Richard M. Hoffman, MD, MPH, Michael J. Barry, MD, Janet L. Stanford, PhD, Ann S. Hamilton, PhD, William C. Hunt, MS, and Mary McNaughton Collins, MD, MPH, appears in The American Journal of Medicine, Volume 119, Number 5 (May 2006), published by Elsevier.