Aggressive Approach to Prostate Cancer Among Older Men
PSA screening and aggressive treatment are common among older men.

This trio of studies will be of interest to those who question whether prostate cancer screening, and aggressive treatment of localized prostate cancer, have become excessive.

Even authorities who favor PSA screening generally believe that elderly men are unlikely to benefit from PSA screening. In an analysis of 1999–2002 data from the National Ambulatory Medical Care Survey, researchers determined the prevalence of PSA testing during nearly 15,000 office visits (to U.S. urologists, internists, and family physicians) by men without prostate cancer. Extrapolating from these data, the authors estimate PSA testing rates to be about 28% for men older than 75.

Many authorities believe that watchful waiting is appropriate for older men with low-grade localized prostate cancers. In an analysis of data from the U.S. SEER cancer registry, researchers found that among men with localized, well-differentiated prostate cancer, 38% of those aged 70–74 and 19% of those aged 75 and older received aggressive treatment (surgery or radiation) rather than expectant management.

Researchers interviewed 20 patients with newly diagnosed localized prostate cancer immediately after the patients had discussed treatment options with their urologists. Responses indicated that (1) fear and uncertainty led many patients to want treatment as quickly as possible, with minimal deliberation about options; (2) most patients had misconceptions about prostatectomy, with some exaggerating benefits and some exaggerating risks; and (3) many patients relied more on anecdotes (i.e., stories about other people with prostate cancer) than on population-based outcome data.

Comment: These studies confirm what most clinicians would suspect: PSA screening and aggressive treatment of localized prostate cancer are common even among older men for whom benefit is least clear. Many factors, including media hype, ambiguous messages from professional and advocacy groups, and physicians' fear of litigation, undoubtedly contribute to these trends.

— Allan S. Brett, MD

Published in Journal Watch September 14, 2006



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