Renal & Urology NewsProstate Cancer Death Rate Low in Older Men Receiving PSA Screening

Prostate Cancer Screening in Older Men: Low Mortality and Implications for Personalized Healthcare

This comprehensive analysis focuses on the outcomes of routine prostate cancer screening in older men, drawing on extensive data from the European Randomized Study of Screening for Prostate Cancer trial. It highlights the correlation between prostate-specific antigen (PSA) levels, screening intervals, and mortality rates, alongside the efficacy of treatments for metastatic hormone-sensitive prostate cancer (mHSPC). The study offers critical insights for physicians, underscoring the importance of personalized screening strategies and treatment approaches in elderly patients.

Key Points:

1. Low Mortality in Older Men: Among 7,052 men routinely screened in the Rotterdam section of the trial, only 0.54% died from prostate cancer by age 85, indicating a low overall mortality rate.
2. PSA Levels and Prostate Cancer Death: A crucial finding is that each doubling of PSA levels was linked to a 2.0-fold increased risk of prostate cancer death.
3. Influence of Benign Prostate Biopsy and Hypertension: Men with a history of benign prostate biopsy or hypertension showed a 59% and 52% decreased risk of prostate cancer death, respectively.
4. Screening Guidelines Divergence: The US Preventive Services Task Force advises against routine PSA screening past age 70, while the American Urological Association allows for personalized screening decisions.
5. Baseline PSA and Cancer Risk: Baseline PSA levels in men aged 55-69 correlate significantly with prostate cancer risk, with higher PSA levels indicating greater risk.
6. Survival with mHSPC in the Elderly: For men over 75 with mHSPC, enzalutamide combined with ADT shows a significant survival benefit.
7. Treatment Complications in Older Patients: Older patients are more likely to experience dose interruptions and treatment-emergent adverse events compared to younger patients.

According to the American Cancer Society, the 5-year survival rate for all stages of prostate cancer combined has increased from 66% in the 1970s to nearly 100% today, due to advancements in screening and treatment.

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