Unscreened older men diagnosed with prostate cancer are at increased risk of aggressive disease

Abstract

Purpose To evaluate the relationship between PSA testing history and high-risk disease among older men diagnosed with prostate cancer. Materials and Methods Records from 1993 to 2014 were reviewed for men who underwent radiotherapy for prostate cancer at age 75 or older. Patients were classified into one of four groups based on PSA testing history: 1) no PSA testing, 2) incomplete/ineffective PSA testing, 3) PSA testing, or 4) cannot be determined. Outcomes of interest were National Comprehensive Cancer Network (NCCN) risk group (i.e. low, intermediate, or high risk) and biopsy grade at diagnosis. Multivariable logistic regression was used to determine the association between PSA testing history and high risk cancer. Results PSA testing history was available in 274 (94.5%) of 290 subjects meeting study criteria. In total, 148 men (54.0%) underwent PSA testing with follow-up biopsy, 72 (26.3%) underwent PSA testing without appropriate follow-up, and 54 men (19.7%) did not undergo PSA testing. Patients who underwent PSA testing were significantly less likely to be diagnosed with NCCN high risk cancer (23.0% vs. 51.6%, p<0.001). On multivariable analysis, men with no/incomplete PSA testing had more than three-fold increased odds of high risk disease at diagnosis (OR 3.39, 95% CI 1.96-5.87, p<0.001) as compared the tested population. Conclusions Older men who underwent no PSA testing or incomplete testing were significantly more likely to be diagnosed with high-risk prostate cancer than those who were previously screened. It is reasonable to consider screening in healthy older men likely to benefit from early detection and treatment.

Prostate cancer screening—when to start and how to screen?

“…The study showed that starting screening at an earlier age advanced the time of PCa diagnosis but did not increase the risk of being diagnosed, suggesting that starting early does not increase the risk of overdiagnosis, whereas the age for stopping screening does ( 31 ). A study from Johns Hopkins showed that older men (75+) who underwent radiotherapy for PCa and who had no history of PSA testing presented with worse disease (more high-risk and high-grade PC) than men who were previously screened ( 32 ). Weight et al ( 33 ) suggest that there is no advantage in starting screening at age 40 instead of 50.…”

Population of elderly patients with cancer – a growing public health problem in the perspective of national health programmes in Poland

“…The odds ratio for detecting high-risk disease in this case is 3.39. However, it is unclear whether this is associated with a higher incidence of metastatic cancer or higher cancer mortality (11).…”

Prostate cancer susceptibility and growth linked to Y chromosome genes

“…A low Gleason score means the cancer tissue is similar to normal prostate tissue and the tumor is less likely to spread; a high Gleason score indicates the cancer tissue is very different from normal prostate and is more likely to spread. Several factors contribute to prostate cancer, one major risk factor is increased age until 70 years and then declines thereafter (10). Another risk factor is gonorrhea; however, the reason for this association has not been established (11).…”