Prostate cancer screening not supported for older men

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Findings from a new study provide further evidence that screening for prostate cancer in older men is not worthwhile and may actually result in adverse outcomes. Aggressively treating screen-detected cancers has minimal effect on survival in this age group, according to the study, but markedly impairs quality of life.

Screening usually picks up localized prostate cancer. Given the slow growth typical of this malignancy, the conventional wisdom has been that even if untreated, older men with screen-detected disease are more likely to die with prostate cancer rather than from it. This point, coupled with the risks of aggressive prostate cancer treatments, has led many to question the value of screening in older men.

In the present study, reported in the American Journal of Medicine for May, Dr. Richard M. Hoffman, from the New Mexico VA Health Care System, and colleagues assessed the outcomes of 465 men, between 75 and 84 years of age, who received aggressive or conservative management for localized prostate cancer.

Of the subjects, 175 constituted the aggressive treatment group, having been treated with radical prostatectomy or radiation therapy. The conservative management group included the remaining 290 patients who received hormone therapy or no treatment.

Aggressive treatment had little impact on disease-specific survival, the report indicates. Although mortality hazard ratio favored such treatment, the absolute difference in 5-year disease-specific survival was just 6%: 98% vs. 92%. Moreover, in agreement with previous reports, the large majority of all deaths -- 80% -- were not due to prostate cancer.

At 2-year follow-up, aggressive treatment was more likely to adversely impact quality of life than was conservative management. Compared with conservatively managed patients, those treated with aggressive therapy were roughly three times more likely to report daily urinary leakage and complain of sexual problems and five times more likely to be bothered by urinary problems.

"Most professional organizations, even those that support prostate cancer screening, recommend that we probably shouldn't be screening men who are over 75," Dr. Hoffman told Reuters Health.

"In our study, we found that men who were treated aggressively ended up having a lot more sexual and urinary problems" than men treated conservatively, yet experienced little or no survival benefit, he added. "We think this reinforces the notion that screening older men should really be done very cautiously."

Dr. Hoffman emphasized that "there is no evidence that prostate cancer screening is of any benefit to older men and we're finding now that there's evidence of harm."