Prostate cancer screening among elderly men: should we diagnose or not?
Prostate cancer is a major issue in cancer incidence and mortality worldwide. The effects of screening on prostate cancer mortality are controversial, and data regarding this topic among elderly men are still lacking. The large prospective studies ERSPC and PLCO included few men aged over 70 years, and none over 75 years. In Brazil, data assessing prostate cancer screening are limited, and underprivileged people have difficulties in the access to specialized healthcare system. Screening has not been systematically performed in a large proportion of the Brazilian population. We hypothesized that individuals aged over 70 years, not previously screened, may present more aggressive disease at diagnosis. Our objectives were to compare prevalence and aggressiveness of prostate cancer diagnosed in men aged 70 years and above.
We performed a cross-sectional study including 17,571 volunteers in Brazil, from 231 municipalities of 6 Brazilian states visited by a Mobile Cancer Prevention Unit program, between 2004 and 2007. Screening was performed by digital rectal examination and prostate-specific antigen (PSA) measurement. The criteria for prostate biopsy were: PSA>4.0ng/ml, or PSA 2.5-4.0ng/ml with free/total PSA ratio ≤15%, or suspicious digital rectal examination. The screened men were stratified in two age groups (45-69 years old, and ≥70 years old). These groups were compared regarding prostate cancer prevalence and aggressiveness criteria (PSA level, Gleason score from biopsy and TNM staging).
The prevalence of prostate cancer in our study was 3.71%. The group of men aged 70 years and above presented disease prevalence about 3 times higher than the group of younger men (prevalence ratio - PR 2.9; p<0.001), and greater likelihood to present prostate cancer with PSA level above 10.0ng/ml (<I>odds radio - OR 2.63; p=0.003). The group of elderly men also presented prevalence of histologically aggressive disease (Gleason 8-10) 3.59 times higher (p<0.001) and greater prevalence of metastases (PR 4.95; p<0.05). </p>
Men aged 70 years and above presented higher prevalence of prostate cancer and higher probability to present high-risk disease at diagnosis, when compared to men aged 45-69 years. Screening of prostate cancer in men aged over 70 years and life expectancy over 10 years may be relevant in Brazil.