Prostate cancer testing following a negative prostate biopsy: over testing the elderly

Area of Science:

• Geriatric Medicine
• Urology
• Oncology

Background:

• Prostate cancer screening in elderly men is generally not recommended.
• Definitive treatments for prostate cancer may not extend life expectancy in older individuals.

Purpose of the Study:

• To describe clinical outcomes in men aged 65 and older following a negative prostate biopsy.
• To evaluate subsequent diagnostic procedures and cancer detection rates in this population.

Main Methods:

• Retrospective cohort study utilizing Medicare and SEER databases.
• Included 7,119 Medicare-eligible men aged 65+ with an initial negative prostate biopsy.
• Follow-up through 1997 to ascertain survival, PSA testing, repeat biopsies, and cancer diagnosis.

Main Results:

• Overall 5-year survival was 79.4%, but lower in older age groups (75-79: 74.6%; 80+: 55.0%).
• Approximately 75% of the cohort underwent PSA testing, with similar rates in older men.
• 20-29% of men aged 75+ had repeat biopsies, and 8-11% were diagnosed with cancer, with ~34% receiving definitive treatment.

Conclusions:

• A significant proportion of older men (75+) undergo continued PSA testing and repeat biopsies after a negative initial prostate biopsy.
• Given the potential harms and uncertain benefits of treating localized prostate cancer in the elderly, continued screening may be inappropriate.
• This highlights a need to re-evaluate screening protocols for elderly men post-negative biopsy.