Contrary to popular belief, a new study says you’re never too old to get high-risk prostate cancer (PCa). There’s been a recent trend to cut back on PSA screening for men over age 70. It wasn’t that long ago when such organizations as the American Urological Society and the American Society of Clinical Oncology promoted the view that “…screening of elderly males with relatively short life expectancy is not appropriate medical care.”^[i] In fact, according to a Johns Hopkins article, PSA screening most benefits men ages 55-69 because that’s when men are most likely to get cancer, and treatment benefits outweigh any potential side effect risks.

To screen or not to screen? That was the question, based on the fact that the PSA test can hint at a suspicion of cancer that subsequently leads to over-biopsy and over-treatment; this dynamic meant countless men were left unnecessarily left damaged in terms of sex and urination. Much of the confusion over this issue was generated by a voluntary Government advisory panel, the U.S. Preventive Services Task Force, as it seesawed back and forth about it between the years of 2012 – 2017. The upshot was a drop in screening, especially by primary care physicians (PCPs).

Thus, when fewer PSA tests were routinely performed, that same period witnessed an alarming rise in the rate of diagnosing more aggressive PCa. It appeared to experts that unscreened men were innocently walking around thinking they didn’t have PCa, yet their undetected early stage disease was mutating in a deadly direction in their own bodies. That’s a pretty big problem, so the pendulum is gradually swinging back toward PSA screening, but with certain guidelines meant to optimize it.

A different problem

As it turns out, there’s another big problem, according to a new study out of Norway.^[ii] The study involved 20,356 men diagnosed with PCa from 2014-17. The statistics revealed that older men (ages 75-79) have 6 times more risk of being diagnosed with high-risk disease than men ages 55-59 years. Here’s a table showing the statistical proportions by age group of men diagnosed with Gleason score 8-10 disease:

Ages 55-59	16.5%
Ages 65-69	23.4%
Ages 75-79	37.2%
Ages 85-89	59.9%

Contrary to the conventional bias that as men get closer to their 80s there’s little point in PSA testing because the odds are low that it will add to their quality or quantity of life, the Norwegian team concluded, “The risk of clinically significant localized PCa increases with age. Healthy older men may benefit from screening.” In short, it’s a myth that healthy older men can dispense with PSA tests.

Taking the panic out of PSA

No matter how young or old a man is, it’s never a good feeling to be told by a doctor that your PSA test came back high and you should have a needle biopsy. There’s that moment of high anxiety: Do I have cancer?! But there’s no reason to panic because there’s an intermediate step between blood draw and needle biopsy. It has long been the mission of our Center to dispel fear by providing noninvasive multiparametric MRI to learn if a biopsy is justified. Using our powerful 3T MRI, we apply several different imaging sequences to develop a 3-dimensional portrait of a man’s prostate that reveals if there’s a suspicious area.

If there is, we can perform an in-bore, real-time MRI guided targeted biopsy that minimizes the number of needles yet maximizes diagnostic accuracy. And if no suspicious area is seen, follow-up consists of repeat PSA tests at regular intervals in conjunction with MRI scans as needed, based on PSA results. A growing body of published research supports this approach to detection and diagnosis, not only because it has the greatest benefit to patients, but also because in the long run it saves medical dollars.

It is sobering to think that as old age approaches, the risk of developing dangerous PCa increases. The Norwegian study does us the favor of busting the myth that beyond a certain age, PSA screening isn’t worth the effort. It is our position that as the years advance, every healthy male is worth screening. Early detection indeed saves lives, and PSA screening plus multiparametric MRI assures that PCa will not get the best of older men.

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] Kaiser, Chris. “Why Are We Screening at Age 75?” MedPage Today, Oct. 15, 2013. https://www.medpagetoday.com/urology/urology/42290
[ii] Huynh-Le MP, Myklebust TÅ, Feng CH, Karunamuni R et al. Age dependence of modern clinical risk groups for localized prostate cancer – A population-based study. Cancer. 2020 Jan 3. doi: 10.1002/cncr.32702. [Epub ahead of print]