Prostate cancer (PCa) is considered an aging-related disease. The older a man becomes, the more likely he will develop it. It is the most common cancer in older men.^[i] The Prostate Cancer Foundation says, “Although only about 1 in 456 men under age 50 will be diagnosed, the rate shoots up to 1 in 54 for ages 50 to 59, 1 in 19 for ages 60 to 69, and 1 in 11 for men 70 and older.” In fact, PCa is more than twice as likely after 70, with four times the risk of advanced PCa when a man is more likely to die from it.

There are two current population trends. First, U.S. on average, American men live longer and healthier than their fathers did. That fact that from 1950-2010 men gained in longevity is largely attributed to less premature death from cardiovascular disease.^[ii] Second, there is an increasing rate of PCa diagnosis when it is already advanced. This frightening observation has been connected with a drop in PSA screening per changing guidelines from the U.S. Preventive Services Task Force.^[iii]

As of this writing, the Task Force currently recommends that men ages 55-69 make a shared decision with their doctors regarding the advantages and disadvantages of annual PSA blood tests. Once they reach age 70, the Task Force advises men to stop screening. However, experts agree that the right age to discontinue screening remains under debate. If a man over 70 is at higher risk for being diagnosed with advanced disease for biological reasons due to aging, is it ever safe to stop annual screening?

New study offers helpful guidance

A team of researchers conducted a new long-term analysis PCa mortality data to determine which older men will benefit from continued annual screening.^[iv] Their results offer valuable guidance that can help doctor-patient discussions.

The study population included over 7000 men who were ages 70-74 at their last PCa test, and who had not been diagnosed with PCa per their three previous screenings. These men were followed for an average of 16 years; their available medical records allowed a calculation prostate cancer specific mortality (PCSM) by age 85, meaning how many died specifically from PCa by that age. The team discovered that across the entire population, the PCSM rate was only 0.54%. However, the rate was found to increase as men’s PSA test results rose:

• PCSM rate 0.85% for PSA 2-3 ng/mL
• PCSM rate 6.8% for PSA ≥ 6.5 ng/mL.

They found that PSA, previous negative prostate biopsy, and high blood pressure were “significantly associate with PCSM.”

Based on these findings, the team wrote:

Men aged 70–74 yr who have previously undergone PSA-based screening without receiving a PCa diagnosis have a very low risk of dying from PCa by the age of 85 yr. These data suggest that screening may be discontinued in men with PSA <3.0 ng/ml or previous benign prostate biopsies. Those with higher PSA levels and no prior biopsies may consider continued screening if life expectancy exceeds 10 yr.

The authors note that a key element in decision-making is life expectancy. In the U.S. today, men can expect to live an average of 76.1 years (compare that with 81.1 years for women). Factors that can help determine are not only your gender and genetics, but also your current health and lifestyle (diet, exercise, stress management), education, socioeconomic and marital status, etc.

In short, there is a complex cost/benefit formula underlying the PCa question, what is YOUR safe age to stop PSA screening? At our Center, we suggest that after age 70, a healthy man with at least 10 years of life expectancy continue an annual PSA blood test, followed by 3T multiparametric MRI if there is a suspicious result. Adding such high-resolution imaging will reveal if there is a concerning prostate abnormality. This provides the advantage of avoiding an unnecessary biopsy if none is warranted, while recording a prostate baseline for any future suspicious activity.

The debate of PSA screening aging men will continue. It is our hope that the study described above sheds light on each individual’s situation, and reduces fear over missing a PCa diagnosis while it is still early and amenable to local treatment or Active Surveillance.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Crawford ED. Epidemiology of prostate cancer. Urology. 2003;62(6 suppl 1):3–12.
[ii] Klenk, J., Keil, U., Jaensch, A. et al. Changes in life expectancy 1950–2010: contributions from age- and disease specific mortality in selected countries. Popul Health Metrics 14, 20 (2016).
[iii] Marabella, Courtney.”Evidence mounts that rise in metastatic prostate cancer is linked to PSA screening reduction.” Urology Times, Feb. 16, 2021. https://www.urologytimes.com/view/evidence-mounts-that-rise-in-metastatic-prostate-cancer-is-linked-to-psa-screening-reduction
[iv] de Vos II, Remmers S, Hogenhout R, Roobol MJ; ERSPC Rotterdam Study Group. Prostate Cancer Mortality Among Elderly Men After Discontinuing Organised Screening: Long-term Results from the European Randomized Study of Screening for Prostate Cancer Rotterdam. Eur Urol. 2023 Oct 31:S0302-2838(23)03207-4.