Prostate cancer screening in older men: Both good and bad news

Men age 75 years and older may not benefit from prostate cancer screening because they are at risk of adverse outcomes from aggressive treatment of localized disease, according to a study published in the American Journal of Medicine (2006; 119:418-25). However, the study found that men who are aggressively treated do have a slightly reduced absolute risk of dying from prostate cancer.

In the population-based cohort study, researchers followed 465 men age 75 to 84 years 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, outcomes, and survival 2 years after the original diagnosis. Survival was also evaluated 7 years after diagnosis.

“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” said Richard M. Hoffman, MD, MPH, of New Mexico VA Health Care System and the University of New Mexico Cancer Research and Treatment Center, Albuquerque. “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.”