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Should older men be screened for prostate cancer?
May 02, 2006Screening 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."
American Journal of Medicine
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."
American Journal of Medicine
Prostate Cancer Screening Current Events and Prostate Cancer Screening News RSSNew finding suggests prostate biopsy is not always necessary
Researchers at Wake Forest University School of Medicine and the University of Wisconsin-Madison have discovered that some elevated prostate-specific antigen (PSA) levels in men may be caused by a hormone normally occurring in the body, and are not necessarily a predictor of the need for a prostate biopsy.
Experts issue call to reconsider screening for breast cancer and prostate cancer
Twenty years of screening for breast and prostate cancer - the most diagnosed cancer for women and men - have not brought the anticipated decline in deaths from these diseases, argue experts from the University of California, San Francisco and the University of Texas Health Science Center at San Antonio in an opinion piece published in the "Journal of the American Medical Association."
Physician trust, early screening reduces disparities for prostate cancer
Men who have a regular, ongoing relationship with a health care provider are more likely to receive prostate cancer screening and less likely to be diagnosed with advanced prostate cancer, regardless of their race, according to a University of North Carolina study published in the current issue of the journal Cancer.
Report: Prostate cancer screening has yet to prove its worth
The recent release of two large randomized trials suggests that if there is a benefit of screening, it is, at best, small.
Genetic marker may predict early onset of prostate cancer
Fox Chase Cancer Center researchers have identified a genetic marker that is associated with an earlier onset of prostate cancer in Caucasian men who have a family history of prostate cancer.
AUA counters mainstream recommendations with new best practice statement on PSA testing
he American Urological Association (AUA) today issued new clinical guidance - which directly contrasts recent recommendations issued by other major groups - about prostate cancer screening, asserting that the prostate-specific antigen (PSA) test should be offered to well-informed, men aged 40 years or older who have a life expectancy of at least 10 years.
U.S. trial shows no early mortality benefit from annual prostate cancer screening
The prostate cancer screening tests that have become an annual ritual for many men don't appear to reduce deaths from the disease among those with a limited life-expectancy, according to early results of a major U.S. study involving 75,000 men.
Racial disparities decline for cancer in Missouri
Cancer death rates in the United States are highest among African Americans, but a new report shows that in Missouri the disparity in cancer incidence and death between African Americans and whites is declining.
Anti-inflammatory drugs may mask prostate cancer marker
Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, may reduce serum levels of the prostate biomarker, PSA (prostate specific antigen), and hence may alter the detection of prostate cancer in individuals who take these medications.
Health risk behaviors associated with lower prostate specific antigen awareness
According to a study conducted at Columbia University Mailman School of Public Health, health risk behaviors such as smoking and obesity are associated with lower awareness of the Prostate Specific Antigen (PSA), which could lead to a lower likelihood of undergoing actual prostate cancer screening.
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