Point: TheValue of Predicting Life Expectancy in Men with Clinically Localized Prostate Cancer

The prediction of life expectancy in prostate cancer screening and treatment is a controversial topic that evokes various opinions regarding its validity. The authors believe incorporating life expectancy prediction into the treatment algorithms for prostate cancer is important. Using a combination of clinical judgment and specific predictive tools, physicians can estimate the life expectancy of patients with prostate cancer. These estimates can then be used to help guide treatment discussion. Estimating life expectancy benefits older men in whom decisions regarding the best form of treatment may be difficult.

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Population-Based Patterns and Predictors of Prostate-Specific Antigen Screening Among Older Men in the United States

Journal of Clinical Oncology ◽

10.1200/jco.2010.31.9004 ◽

2011 ◽

Vol 29 (13) ◽

pp. 1736-1743 ◽

Cited By ~ 75

Author(s):

Michael W. Drazer ◽

Dezheng Huo ◽

Mara A. Schonberg ◽

Aria Razmaria ◽

Scott E. Eggener

Keyword(s):

Prostate Cancer ◽

United States ◽

Cancer Screening ◽

Life Expectancy ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

Older Men ◽

The United States ◽

Population Based ◽

Psa Screening

Purpose For patients who elect to have prostate cancer screening, the optimal time to discontinue screening is unknown. Our objective was to describe rates and predictors of prostate-specific antigen (PSA) screening among older men in the United States. Methods Data were extracted from the population-based 2000 and 2005 National Health Interview Survey (NHIS). PSA screening was defined as a PSA test as part of a routine exam within the past year. Demographic, socioeconomic, and functional characteristics were collected, and a validated 5-year estimated life expectancy was calculated. Age-specific rates of PSA screening were determined, and sampling weight-adjusted multivariate regressions were fitted to determine predictors of screening among men age 70 years or older. Results The PSA screening rate was 24.0% in men age 50 to 54 years, and it increased steadily with age until a peak of 45.5% among age 70 to 74 years. Screening rates then gradually declined by age, and 24.6% of men age 85 years or older reported being screened. Among men age 70 years or older, screening rates varied by estimated 5-year life expectancy: rates were 47.3% in men with high life expectancies (≤ 15% probability of 5-year mortality), 39.2% in men with intermediate life expectancies (16% to 48% probability), and 30.7% in men with low life expectancies (> 48% probability; P < .001). In multivariate analysis, estimated life expectancy and age remained independently associated with PSA screening (P < .001 for each). Conclusion Rates of PSA screening in the United States are associated with age and estimated life expectancy, but excessive PSA screening in elderly men with limited life expectancies remains a significant problem. The merits and limitations of PSA should be discussed with all patients considering prostate cancer screening.

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Prostate Cancer Screening in Jamaica: Results of the Largest National Screening Clinic

Journal of Cancer Epidemiology ◽

10.1155/2016/2606805 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Belinda F. Morrison ◽

William Aiken ◽

Richard Mayhew ◽

Yulit Gordon ◽

Marvin Reid

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

Older Men ◽

Gradual Reduction ◽

Cancer Society ◽

Prostate Biopsies ◽

The Mean ◽

Screening Clinic

Prostate cancer is highly prevalent in Jamaica and is the leading cause of cancer-related deaths. Our aim was to evaluate the patterns of screening in the largest organized screening clinic in Jamaica at the Jamaica Cancer Society. A retrospective analysis of all men presenting for screening at the Jamaica Cancer Society from 1995 to 2005 was done. All patients had digital rectal examinations (DRE) and prostate specific antigen (PSA) tests done. Results of prostate biopsies were noted. 1117 men of mean age 59.9 ± 8.2 years presented for screening. The median documented PSA was 1.6 ng/mL (maximum of 5170 ng/mL). Most patients presented for only 1 screen. There was a gradual reduction in the mean age of presentation for screening over the period. Prostate biopsies were requested on 11% of screening visits; however, only 59% of these were done. 5.6% of all persons screened were found to have cancer. Of the cancers diagnosed, Gleason 6 adenocarcinoma was the commonest grade and median PSA was 8.9 ng/mL (range 1.5–1059 ng/mL). Older men tend to screen for prostate cancer in Jamaica. However, compliance with regular maintenance visits and requests for confirmatory biopsies are poor. Screening needs intervention in the Jamaican population.

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Do Older Men Benefit From Curative Therapy of Localized Prostate Cancer?

Journal of Clinical Oncology ◽

10.1200/jco.2003.09.034 ◽

2003 ◽

Vol 21 (17) ◽

pp. 3318-3327 ◽

Cited By ~ 133

Author(s):

Shabbir M.H. Alibhai ◽

Gary Naglie ◽

Robert Nam ◽

John Trachtenberg ◽

Murray D. Krahn

Keyword(s):

Prostate Cancer ◽

Life Expectancy ◽

External Beam Radiotherapy ◽

Case Series ◽

Older Men ◽

Localized Prostate Cancer ◽

Series Data ◽

Curative Therapy ◽

Poorly Differentiated ◽

Modern Radiotherapy

Purpose: Prior decision-analytic models are based on outdated or suboptimal efficacy, patient preference, and comorbidity data. We estimated life expectancy (LE) and quality-adjusted life expectancy (QALE) associated with available treatments for localized prostate cancer in men aged ≥ 65 years, adjusting for Gleason score, patient preferences, and comorbidity. Methods: We evaluated three treatments, using a decision-analytic Markov model: radical prostatectomy (RP), external beam radiotherapy (EBRT), and watchful waiting (WW). Rates of treatment complications and pretreatment incontinence and impotence were derived from published studies. We estimated treatment efficacy using three data sources: cancer registry cohort data, pooled case series, and modern radiotherapy studies. Utilities were obtained from 141 prostate cancer patients and from published studies. Results: For men with well-differentiated tumors and few comorbidities, potentially curative therapy (RP or EBRT) prolonged LE up to age 75 years but did not improve QALE at any age. For moderately differentiated cancers, potentially curative therapy resulted in LE and QALE gains up to age 75 years. For poorly differentiated disease, potentially curative therapy resulted in LE and QALE gains up to age 80 years. Benefits of potentially curative therapy were restricted to men with no worse than mild comorbidity. When cohort and pooled case series data were used, RP was preferred over EBRT in all groups but was comparable to modern radiotherapy. Conclusion: Potentially curative therapy results in significantly improved LE and QALE for older men with few comorbidities and moderately or poorly differentiated localized prostate cancer. Age should not be a barrier to treatment in this group.

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