Prostate cancer continues to be one of the most common cancers in men. Yet the approach to screening and treatment remains controversial, especially among older populations.  Studies examining prostate cancer mortality rates and treatment approaches were presented during the 110th Annual Scientific Meeting of the American Urological Association (AUA) in New Orleans.  Four of these studies looked at the impact current trends related to screening and treatment of prostate cancer can have on patients, including:

• Comparison of prostate cancer-related deaths across all major treatment options;
• Analyzing increased risk of death in older adult men diagnosed with prostate cancer;
• Assessment of how age and comorbidity affect treatment approaches in men with high risk, non-metastatic prostate cancer;
• Evaluating the prostate specific antigen (PSA) screening history in men who have metastatic prostate cancer and/or have died from the disease.

The largest study, Long-Term Comparative Mortality Outcomes across Different Primary Treatments for Prostate Cancer (abstract PD43-01), used data from CaPSURE— a community-based prostate cancer registry of 47 clinical sites across the U.S. (since 1995).  Researchers at the University of California, San Francisco, CA, compared prostate cancer-specific deaths across all major treatment alternatives, including local treatment, surgery, brachytherapy, external-beam radiation and primary hormonal therapy. The study found active surveillance was a viable option for most men with low-risk prostate cancer and aggressive multimodal treatment, including surgery, was effective for men with high-risk disease.

A study, Prostate Cancer in the Elderly (abstractMP60-03), found that men over the age of 70 years were just as likely to die of prostate cancer as they were from other causes, according to new research from Stratton Veterans Affairs Medical Center, Albany, NY. Using records of 545 patients diagnosed at the Stratton Veterans Affairs Medical Center, researchers categorized patients by age group and found the oldest group (aged 70-99) had the highest percentage of high-risk prostate cancer (41.1 percent had a stage of >T2b, 41.1 percent had a Gleason grade of 8-10, and 73.4 percent had a PSA >20), while the youngest group (aged 40-49) had the highest percentage of low-risk disease. The mortality rate from prostate cancer was as high as that from other causes. These data suggest prostate cancer may not be innocuous in older adults.

In a study of Undertreatment of Men in Their Seventies with High Risk, Non-Metastatic Prostate Cancer (abstractMP56-17), researches showed that age and co-morbidities may affect treatment decisions in older adult men. New data from New York University, New York, NY; Umeå University, Umeå; Karolinska Institute, Stockholm; Sahlgrenska University Hospital, Gothenburg; Uppsala University Hospital, Uppsala; and Lund University, Helsingborg in Sweden demonstrate that otherwise healthy men in their seventies with high-risk, non-metastatic prostate cancer (HRnMPCa) are less likely than younger men with similar life expectancies to receive curative treatment. The nationwide register study evaluated 19,190 men with HRnMPCa who were diagnosed in Sweden from 2001 to 2012, to assess how age and comorbidities effect treatment. Results from the study showed:

• The proportion of men under the age of 70 who got curative treatment for HRnMPCa varied depending on life expectancy, but this was not the case for men in their seventies.
• Only 10 percent of men ages 75-80 with no comorbidities received curative treatment despite a 52 percent 10-year survival probability, compared to half of men younger than 70 with a similar life expectancy.

Finally, in the study, Metastatic Prostate Cancer in the Modern Era of PSA Screening, researchers found that men who develop incurable prostate cancer may not be failures of screening, but may have never undergone appropriate testing in the first place, according to researchers at the University of Kansas Medical Center, Kansas City, KS, who evaluated current trends of standard screening (first prostate-specific antigen, or PSA, test prior to age 55). Using records of 93 men diagnosed with prostate cancer with metastatic disease or who died from the disease between 2008 and 2014, patients were stratified into four groups by disease presentation. Results showed:

• Of men treated for localized prostate cancer who later had metastasis or death from the cancer, only four (15.4 percent) had standard screening with a test before age 55.
• Most of the men had metastatic disease at presentation. Only nine percent of those with symptomatic metastatic prostate cancer had undergone standard screening prior to diagnosis, while 28 percent of men with asymptomatic metastatic prostate cancer had undergone standard screening.

"These studies suggest that active surveillance should be encouraged for men with low-risk prostate cancer, but we are undertreating some older men with high risk prostate cancer," said Stacy Loeb, MD, session moderator and assistant professor of urology and population health at New York University. "Also most men with lethal prostate cancer did not have their first PSA test until after age 55, which is too late."