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Sandeep Mistry1, Wesley Mayer, Rose Khavari

  • 1Scott Department of Urology, Baylor College of Medicine, Houston, Tex.

Canadian Urological Association Journal = Journal De L'Association Des Urologues Du Canada
|June 23, 2009
PubMed
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Prostate cancer is common in elderly men, with over half of biopsies showing cancer. Clinically significant prostate cancer is prevalent in men over 75, suggesting continued screening benefits.

Area of Science:

  • Urology
  • Oncology
  • Geriatric Medicine

Background:

  • Prostate cancer is a leading cause of cancer death in North America, with incidence rising with age.
  • Current guidelines suggest halting prostate cancer screening in men over 75, assuming most have insignificant disease.
  • The actual prevalence of clinically significant prostate cancer in this elderly demographic remains unknown.

Purpose of the Study:

  • To determine the prevalence of clinically significant prostate cancer in men aged 75 and older.
  • To evaluate the impact of age and prostate-specific antigen (PSA) levels on cancer diagnosis in this population.
  • To assess the effectiveness of current PSA screening thresholds in identifying significant prostate cancer in elderly men.

Main Methods:

  • Analysis of 1446 prostate needle biopsies from men aged 75+.

Related Experiment Videos

  • Pathological review by the Methodist Hospital pathology department.
  • Data collection included age, serum PSA, biopsy results, and Gleason grade; statistical analysis used Stata.

    • Main Results:

    • 53% of biopsies were positive for prostate cancer; 78% of these were clinically significant.
    • Age was a significant factor for increased Gleason grade and clinically significant cancer, even when controlling for PSA.
    • Higher PSA thresholds (e.g., 6.5 or 4.0 mug/L) would have missed a substantial percentage of significant cancers.

    Conclusions:

    • Clinically significant prostate cancer appears more prevalent in the elderly than previously assumed.
    • Higher PSA thresholds are ineffective for identifying elderly men at risk for significant prostate cancer.
    • Testing and treatment recommendations should consider the potential benefits of identifying aggressive prostate cancer in men over 75.