“The incidence of prostate cancer increases dramatically with age,” says a report by Sandeep Mistry, MD and colleagues.
Mistry et al’s paper, published in the June 2009 Canadian Urological Association Journal, points out that routine prostate cancer screening in men older than 75 is discouraged by many doctors.
The paper states that those who advocate cessation of screening believe that “most patients will have a clinically insignificant cancer [if one is found] and will not benefit from therapy.”
However, the actual prevalence of these kinds of prostate cancers in the elderly is not known.
Dr. Mistry’s investigation involved 1,446 needle biopsies in men 75 and older.
How Old Is Too Old to Get Threatening Prostate Cancer?
The investigation explains that the prevalence of clinically significant prostate cancer in men 75 or older “may be higher than previously thought.”
Identifying men at a bigger risk of threatening prostate cancer, by using a higher serum PSA threshold, is not effective.
The paper adds that biopsies should not be avoided, even if it means potential over-diagnosis (and its ensuing over-treatment) of non-aggressive tumors.
How old is too old for prostate cancer, then?
“Never,” says Jonathan W. Simons, MD, President and Chief Executive Officer of the Prostate Cancer Foundation, David H. Koch Chair.
Dr. Simons continues, “Prostate cancer can impact men in their 30s and men in their 90s. In fact, there is a wealth of data to suggest that men over 65 years old have intrinsically more aggressive disease than younger men.
“Therefore, even if you are 70 years old with a diagnosis of high risk prostate cancer, it usually warrants treatment, unless you have less than a five-year life expectancy.”
Treating Elderly Men with Prostate Cancer
The study recommends treatment be based upon an assessment of the patient’s life expectancy, the patient’s preference, and the expectations of the outcome – all based on disease criteria pertaining to that particular patient.
In short, no template approach should be considered.
The Older the Man, the Likelier Death from Prostate Cancer
According to the National Cancer Institute Surveillance, Epidemiology, and End Results Program, as of from 2010 to 2014:
• 34.4% of prostate cancer deaths were in men 75-84
• 33.5% of deaths were in men 85 and older.
Based on that data and nothing else, one might wonder what the average age of diagnosis was for most of those elderly men.
After all, it’s possible to be diagnosed much younger, live with the disease in remission for 20 years, then die from a so-called return of disease.
However, SEER date for age of diagnosis (2010-2014) is:
• 32.8% for 55-64
• 38.2% for 65-74
• 15.3% for 75-84
• 3.9% for over 84
Without more information, it is not possible from the above data to determine the survivability of prostate cancer if diagnosed for the first time in men older than 75.
But certainly, old men do get prostate cancer. Perhaps you’ve been told that if any man lived long enough, they’d eventually develop prostate cancer.
Then again, men are living to past 100 without being diagnosed – but then again also, how many of them are getting screened?
Screening Recommendations for Prostate Cancer: How Old Is Too Old?
The American Urological Association discourages routine PSA screening for men over 70 or for men with less than a 10-15 year life expectancy.
Dr. Simons is an internationally recognized physician-scientist, oncologist and acclaimed investigator in translational prostate cancer research.
