Healthy older men may benefit from prostate cancer screening
medwireNews: The risk for clinically significant prostate cancer rises with age, report researchers who believe that this should be taken into account in the optimization of screening practices.
The team drew on the Cancer Registry of Norway to identify 20,356 men who were diagnosed with prostate cancer in 2014–2017 and assigned them to prostate cancer risk stratification categories based on contemporary definitions. The specific categories were low, favorable intermediate, unfavorable intermediate, high, regional, and metastatic.
There was a significant association between age and prostate cancer risk groups, with older men more likely to have more advanced disease. For example, the incidence of at least high-risk disease was 29.3% among men aged 55–59 years, rising to 39.1%, 60.4%, and 90.6% among those aged 65–69, 75–79, and 85–89 years, respectively. The corresponding rates of low-risk prostate cancer were 24.0%, 17.9%, 10.2%, and 4.1%.
Older men also had a significantly greater likelihood of having clinically significant disease at diagnosis, regardless of whether it was defined as all cases of at least intermediate-risk or all cases of at least unfavorable intermediate-risk prostate cancer.
Additionally, age-specific incidence rates (ASIRs) based on Norwegian population data increased across all risk categories until the ages of 65–69 years, at which point the low- and intermediate-risk cases tailed or leveled off, but high-risk cases continued to rise up to the ages of 75–79 years, declining thereafter.
Of note, the ASIR for high-risk prostate cancer was 408.3 per 100,000 men in the 75–79 year age group, which was more than sixfold greater than the ASIR for high-risk disease in the 55–59 year group, at 61.6 per 100,000 men.
The Gleason score was available for 18,665 cases, and analysis of these patients showed a significant association between age and Gleason score, such that older age at diagnosis correlated with a higher Gleason score at diagnosis. For instance, the proportion of individuals with a Gleason score of 8–10 was 16.5% in the 55–59 year age group, 23.4% in the 65–69 year age group, 37.2% in the 75–79 year age group, and 59.9% in the 85–89 year age group.
In light of these findings, Tyler Seibert (University of California San Diego, La Jolla, USA) and collaborators suggest in Cancer that some healthy men in older age groups “could plausibly benefit from screening because of their high risk of aggressive disease and otherwise good life expectancy.”
They continue: “Decision-making guidelines generally emphasize shared decision making for men aged 50 to 69 years and do not encourage screening of men aged 70 to 75 years, but perhaps the latter should be reconsidered for otherwise healthy men.”
The study authors add a word of caution, however, noting that “[a]lthough our data suggest that screening older men may identify more clinically significant [prostate cancer], it is acknowledged that our data do not prove that screening could influence important clinical outcomes such as survival and quality of life. In addition, the risks of low-risk disease overdiagnosis must be considered.”
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