SIU 2017: Management of Prostate Cancer in Men more than 80 Years of Age: Under or Over Treatment?

Lisbon, Portugal ( As the population ages, we are forced to address cancer in patients at much older ages than previously. While guidelines for prostate cancer suggest stopping screening at age 70-75, as patients’ life expectancy increases, we are finding and managing more men with prostate cancer over the age of 80. But, how do these men fare?

In this study, the group from the UK assess their institutional records for men diagnosed with prostate cancer over the age of 80 between 2014 and 2016. They retrospectively documented diagnostic characteristics, risk stratification and treatment for these patients.

They identified 63 men diagnosed above the age of 80 (median age 85.3). Of these 1 died and 1 did not follow-up – so 61 men were analyzed. Risk stratification demonstrated that men were primarily diagnosed with high-risk disease (77%), and very few low (13%) or intermediate risk (10%). Curative treatment (AS, EBRT, RP) was only offered to 16% of the patients, while palliative (ADT, watchful waiting, chemotherapy) was given to the remaining. 

PSA, Gleason score, and age are important features of decision-making for men with prostate cancer. Elderly patients are less willing to sacrifice quality of life for treatment. Expert guidelines currently recommend treatment for men with 10-years life expectancy. 

It is unclear what this study addresses. Many of these men were likely diagnosed with metastatic disease rather than screening – though there is no discussion about the prompt for diagnosis was. However, with life expectancy age 87 at best in most countries (if not worse), men aged 80 should not be screened for prostate cancer. The few that do develop it later in life may have higher risk disease due to selection. 

Presented by: Nisha Pindoria
Affiliation: North Middlesex Hospital, United Kingdom

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal