BERKELEY, CA (UroToday.com) -
“What would you do if a 75-year-old patient who presents with PSA value of 4 ng/ml visits the clinic?”
The incidence of prostate cancer has been increasing due not only to changes in diet, but also developments in screening and diagnostic methods based on PSA levels. However, because prostate cancer is less aggressive in biopathological status, active treatment steps are not currently being recommended for older patients. This study aims to investigate whether pathologic findings from studies done on Koreans with prostate cancer differ from those done on Western populations. The US Preventative Services Task Force states that prostate cancer screening is insignificant for patients older than 75 years of age. Our findings suggest otherwise, as a greater number of patients older than 70 years were found to be diagnosed with locally advanced cancer than those under 70. In addition, subgroup analysis was performed on patients diagnosed with prostate cancer by dividing those with PSA above 4 ng/ml from below 4 ng/ml, and 25% of patients with PSA below 4 ng/ml were found to have locally advanced cancer. These results suggest that current cut-off values for PSA screening should be lowered, while at the same time, stricter cut-off values are necessary for older patients. Therefore, in older patients, prostate biopsy should be actively recommended in the event that PSA screening results show PSA levels higher than cut-off values.
“What would you do if a 75-year-old patient who presents with PSA value of 4 ng/ml visits the clinic?” Some clinicians would state that PSA screening itself was meaningless, and some would not even bother performing prostate biopsy on the patient. If prostate biopsy were indeed carried out and led to the diagnosis of locally advanced cancer, some clinicians would recommend active surveillance, while others would recommend other conservative management methods, such as hormone therapy, due to the patient’s old age. However, according to the findings of this study, it is also important to take into consideration the patient’s overall health and socioeconomical status and then, if applicable, consider radical eradication as a treatment option.
Koreans are characteristically very anxious. If active surveillance is recommended to a patient diagnosed with prostate cancer, most patients would go to a different hospital for a surgery consultation. Because of such characteristics in the population, a greater number of elderly patients in Korea undergo both prostate biopsy and radical eradication than in Western countries, and, in turn, our institution was able to obtain a relatively larger pool of biopathologic results in order to produce the findings of our studies.
Surgical methods using robots have been improving, and adverse events due to these surgeries have decreased significantly. Average life expectancy is also steadily increasing, and the overall quality of healthcare service for the elderly has greatly developed compared to before. As a result, it will be necessary to reconsider whether to simply continue recommending conservative methods of treatment for elderly prostate cancer patients.
Jung Kwon Kim and Sung Yong Cho as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.