Older men may not need prostate cancer screening

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The findings of a new study provide further evidence that screening older men for prostate cancer is not worthwhile and may actually do harm. Aggressive treatment of prostate cancers detected in patients in this age group has a minimal effect on survival, but markedly impairs quality of life, according to the study.

Screening usually picks up localized prostate cancer. Given the typically slow growth 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 treatment, has led many to question the value of screening in older men.

In the study, reported in the American Journal of Medicine, 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 underwent aggressive or conservative treatment for localized prostate cancer.

The 175 men in the aggressive treatment group underwent prostate surgery 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 the prostate cancer survival rate, the report indicates. The absolute difference in prostate cancer survival over 5 years was similar in both treatment groups. Moreover, in agreement with previous reports, the majority of all deaths—80 percent—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 other 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,” Hoffman told Reuters Health.

“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.”

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.”

SOURCE: American Journal of Medicine, May 2006.

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