Lower urinary tract symptoms in elderly men: Considerations for prostate cancer testing

Area of Science:

• Geriatric Medicine
• Urology
• Oncology

Background:

• Lower urinary tract symptoms (LUTS) and prostate cancer (PCa) are prevalent in elderly men.
• LUTS can trigger prostate-specific antigen (PSA) testing, potentially leading to overdiagnosis of PCa in men with competing health risks.
• There's a gap in understanding the LUTS-PCa relationship and optimal evaluation strategies for older men.

Purpose of the Study:

• To clarify the relationship between LUTS and PCa risk in elderly men.
• To outline an approach for evaluating LUTS in older men to balance PCa detection with avoidance of overdiagnosis.
• To improve patient and provider understanding of PCa risk assessment in the context of LUTS.

Main Methods:

• A literature review was conducted using PubMed.
• Articles published before November 2023 were screened for relevance.
• Keywords focused on LUTS, PCa, elderly men, and diagnostic evaluation.

Main Results:

• LUTS and PCa appear largely independent in elderly men.
• Current PCa risk assessment tools (PSA, biomarkers, imaging) have limitations in older populations.
• A three-tiered evaluation approach for these patients is proposed.

Conclusions:

• Elderly men frequently present with LUTS and a high prevalence of indolent PCa.
• A systematic, shared decision-making approach can optimize detection of aggressive PCa while minimizing over-testing and overdiagnosis.