For men over 75: The Iowa Prostate Cancer Consensus

The Iowa Prostate Cancer Consensus is a set of guidelines recently developed to offer guidance for men of 75 years and older, and their physicians, about the risks and benefits of prostate cancer screening and detection (see Konety et al.). The following text has been kindly provided by the authors of these guidelines, together with their permission to post this material on this web site.

As the population continues to live longer, questions about how long and to what age people should be “screened” for certain diseases, including different types of cancer, will continue to be debated

Since prostate cancer is the second-leading cause of death from non-skin cancer in the United States, men are naturally concerned with whether or not they will develop this disease. In fact, a large proportion of men over the age of 80 will probably have some form of prostate cancer. The good news is that most of them will die with their prostate cancer, not from it. This means that most cases of prostate cancer are very slow-growing and take a long time to reach the point where they need treatment of any kind.

In men over the age of 75, the question of whether or not to look for prostate cancer and then whether or not to treat it if it is found is a little more complicated. This is because the current life expectancy for a 75-year-old man in the U.S. is about 10 years — he is expected to live to age 85.  A man’s life may not be extended by finding and treating prostate cancer unless he is already expected to live at least another 10 years from the time of diagnosis. So, in a 75-year-old man, the dilemma is whether to find and treat a cancer such as prostate cancer, which is not very likely to affect how long he lives, even if the cancer is found and treated.

The Iowa Prostate Cancer Consensus was formed to try to answer these questions in a common-sense manner, using information from some of the country’s leading prostate cancer experts, as well as doctors from other areas of medicine, including family physicians, medical and radiation therapy doctors, internists, geriatricians, physician assistants, and legal and patient-advocate experts.

The panel also surveyed 3,000 health care providers in the state of Iowa who see potential prostate cancer patients routinely, to find out how they screen older men for prostate cancer, and what they recommend for treatment if prostate cancer is found in these men.

After weighing all of the available evidence, the panel proposed the following guidelines:

For men aged 75 or older who have never been screened for prostate cancer (i.e., they have never had a PSA test)

  • Doctors and patients should have an in-depth discussion about what to expect the PSA level to be, according to age. PSA levels naturally rise with age. A level that is normal for a 75-year-old may not be normal for a 55-year-old.
  • In men with certain risk factors (father or brothers have had prostate cancer, African-American race), screening may be helpful, as these men are more likely to develop prostate cancer in general.
  • Men with other diseases or health conditions may not be well-served by screening, because if prostate cancer is found, treatment for it may interfere with the other health concerns. If the prostate cancer is slow-growing, it may be best not to try to treat it.

For men aged 75 and older who have had previous PSA tests done:

  • Doctors and patients should talk about what is likely to be gained by either continuing PSA testing, or stopping it at age 75.

Essentially, it all boils down to doctors and patients being open and honest with one another about what a diagnosis of prostate cancer after age 75 may mean for each man, depending on many factors, including what type of prostate cancer is found (whether it is aggressive or slow growing), what other health concerns the patient may have, and, weighing all the options, what might be the expected outcomes of either living with prostate cancer or attempting to treat it.

Copyright © 2008 The University of Iowa Department of Urology. Reproduced with permission.

This publication was supported by Cooperative Agreement U55/CCU721906-04 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

The Iowa Prostate Cancer Consensus Project was created by the University of Iowa Department of Urology, in partnership with the Iowa Department of Public Health Comprehensive Cancer Control Program, the University of Iowa Holden Comprehensive Cancer Center, and the American Cancer Society, Midwest Division.

The “New” Prostate Cancer InfoLink deeply appreciates the assistance of Dr. Badrinath Konety (of the University of California at San Francisco) and Dr. Richard Williams (of the University of Iowa) in giving permission to publish these guidelines here, and the assistance of Kristina Greiner (of the University of Iowa) in arranging to make this possible.

Content on this page last reviewed and updated May 5, 2008.
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