Prostate Cancer In Men Over 70

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Older Men and Prostate Cancer

With a simple tap, youll receive information about personalized prostate cancer treatment options to help manage your care. This free app includes questions to ask your doc, calendars to keep track of your appointments, and videos that highlight helpful resources. Downloading it is a great way to stay on top of your cancer!

How Common Is Prostate Cancer And Who Is At Risk

Prostate cancer most often affects men between ages 55 and 69. There is a huge gap between the proportion of men diagnosed with prostate cancer and those whose health and lifespan are affected by the disease. American men have a 16 percent lifetime risk of developing prostate cancer, but only 2.9 percent of men die from it.

In fact, many prostate cancers are believed to be slow growing, with men dying from causes other than prostate cancer. Autopsy studies support this, finding that 30 percent of 55-year-old men and 60 percent of men reaching age 80 on whom an autopsy is performed have autopsy-discovered prostate cancer.

There are some factors that increase risk for prostate cancer, including:

Race Race seems to play a role in the frequency and severity of the disease. African-American men are far more likely to develop prostate cancer than white men 203.5 vs. 121.9 cases per 100,000 men. They are also more than twice as likely as white men to die of prostate cancer 44.1 vs. 19.1 deaths per 100,000 men.

Family History Positive family history of prostate cancer is another risk factor.

Elevated Body Mass Index Elevated BMI is another risk factor, linked to an increased risk of prostate-cancer-specific mortality and biochemical recurrence in men with prostate cancer.

What Is Prostate Cancer

Prostate cancer develops when abnormal cells in the prostate gland grow in an uncontrolled way, forming a malignant tumour.

Prostate cancer is the second most common cancer diagnosed in men in Australia and the third most common cause of cancer death. It is estimated that 18,110 new cases of prostate cancer will be diagnosed in Australia in 2021. One in 6 men will be diagnosed with prostate cancer by the age of 85. It is more common in older men, with over 63% of cases diagnosed in men over 65 years of age.

Early prostate cancer refers to cancer cells that have grown but do not appear to have spread beyond the prostate.

There are two stages of advanced prostate cancer:

locally advanced prostate cancer where the cancer has spread outside the prostate to nearby parts of the body or glands close to the prostate
metastatic prostate cancer where the cancer has spread to distant parts of the body.

The five year survival rate for prostate cancer is 95%.

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Nursing Allied Health And Interprofessional Team Monitoring

One of the major concerns regarding prostate cancer screening is overdiagnosis, which involves overtreatment of low-grade prostate cancer and decreasing the quality of life of the patient by adding treatment-associated side effects and psychological harm when in reality, cancer would not have caused any clinical problems in the patient. This outcome can be overcome by active surveillance . Active surveillance is one of the management strategies in which a super select group of low-grade cancer patients are under close monitoring and followed through their disease course with the expectation to intervene only if cancer progresses. This approach will lead to the avoidance of treatment-associated side effects in such patients. This monitoring is only achievable by cumulative efforts and coordination of care amongst the interdisciplinary team members.

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Watchful Waiting And Active Surveillance

Watchful waiting is an adequate approach in patients who are at low risk of death from prostate cancer because of their limited life expectancy due to severe comorbidities.26,27 Watchful waiting resulted in similar overall survival when compared with radical prostatectomy, but disease-specific survival was better in patients who had undergone surgery.26 For some patients it turns out to be hard to persist on a watchful waiting policy, and many men drop out and seek active treatment within several years, mostly when PSA elevation is noted.

Active surveillance is a novel and fascinating approach to distinguish between patients who are at higher risk and need active therapy and patients who are at low risk for disease progression.27,28 This approach avoids the risks of therapy while allowing early detection of those patients who are prone to progress. In these high-risk individuals, delayed active treatment is offered. Periodic monitoring of the PSA serum level, digital rectal exam, and repeated prostate biopsies are performed in patients who are on active surveillance, and active therapy is started when predefined threshold values are reached. This concept makes it possible to offer curative treatment to individuals who are at high risk for disease progression as indicated by active surveillance parameters.

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How To Find Out If You Have Prostate Cancer

Ah, the dreaded, stigmatized prostate exam: a necessity for every man over 50. As weve learned, an symptom of prostate cancer is an enlarged prostate, so the main way doctors test for it is by feeling the prostate. Formally called a digital rectal exam, doctors place a lubricated finger, covered with a glove, up your rectum and feel for the prostate, which is right next to the rectum. The doctor feels for any abnormalities, like if its larger than it should be, feels different than it should, or the shape of it is different. But a DRE is not the be-all, end-all of prostate tests. There are plenty of tests doctors run to confirm a diagnosis. These tests include:

How Is Prostate Cancer Diagnosed

Screenings are the most effective way to catch prostate cancer early. If you are at average cancer risk, youll probably have your first prostate screening at age 55. Your healthcare provider may start testing earlier if you have a family history of the disease or are Black. Screening is generally stopped after age 70, but may be continued in certain circumstances.

Screening tests for prostate cancer include:

Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum and feels the prostate gland, which sits in front of the rectum. Bumps or hard areas could indicate cancer.
Prostate-specific antigen blood test: The prostate gland makes a protein called protein-specific antigen . Elevated PSA levels may indicate cancer. Levels also rise if you have BPH or prostatitis.
Biopsy: A needle biopsy to sample tissue for cancer cells is the only sure way to diagnose prostate cancer. During an MRI-guided prostate biopsy, magnetic resonance imaging technology provides detailed images of the prostate.

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How To Know Whether It Is Cancer

If you have any of the mentioned signs, you should see a doctor. They will take the steps to rule out cancer.

However, you can read here the different options :

· RECTAL EXAMINATION

The doctor checks your prostate through your rectum, with a finger. The prostate is in contact with the rectum so this is the way to palpate it.

By doing so, the doctor can check if it is enlarged, if it has hard nodules

· PSA

It is detected through a blood test. The more prostatic tissue you have, the higher value of PSA you have.

It is useful if you have a normal PSA value because that virtually rules out cancer. If your PSA is okay, your prostate is probably ok.

However, if you have a high PSA then you have more prostatic tissue than normal. Maybe you have BPH .

Prostatitis also causes a high PSA, because of the irritated tissue.

So if PSA is normal then everything is good. If PSA is highyou probably need some extra tests to find out what is wrong.

An increased PSA can be due to prostate cancer, but also to BPH and prostatitis.

· PROSTATE MRI

You go inside the MRI machine and stay still for around 30 minutes.

Usually, it also requires intravenous contrast so you will need an IV line.

This test will tell the doctor if there are any suspiciousnodules inside the prostate. Also, it will show the prostate cancer stage.
It will also show if it is a large prostate, but with no malignant nodules .

If there are no nodules, everythings fine. If there are you may need a biopsy.

· PROSTATE BIOPSY

Deaths From Prostate Cancer

Prostate Cancer: Common Cancer for Men in Their 50s and Older

Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 41 will die of prostate cancer.

Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 3.1 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Cancer Society. Facts & Figures 2022. American Cancer Society. Atlanta, Ga. 2022.

National Cancer Institute. SEER Cancer Stat Facts: Prostate Cancer. Accessed at https://seer.cancer.gov/statfacts/html/prost.html on March 15, 2019.

Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA . SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.

American Cancer Society. Facts & Figures 2022. American Cancer Society. Atlanta, Ga. 2022.

National Cancer Institute. SEER Cancer Stat Facts: Prostate Cancer. Accessed at https://seer.cancer.gov/statfacts/html/prost.html on March 15, 2019.

Last Revised: January 12, 2022

When Is A Psa Test Needed

If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.

Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.

You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

04/2014

Prostate Cancer Treatment Options: What Are They

Prostate cancer is, most often, a slow-growing cancer.

For some men, prostate cancer causes no symptoms or long-term issues, so treatment isn’t necessary.

In these cases, doctors may recommend active surveillance. That is, they’ll keep an eye on the development of the tumor using various tools and tests, including:

Digital rectal exams
Transrectal ultrasounds
Prostate biopsies

Men who require treatment for their condition are most often treated with surgery, radiation therapy, hormone therapy, or a combination of these modalities.

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A Cancer Prevention Plan For Men

Finding cancer early improves your chances of successful treatment and long-term survival.

Look for:

lumps, sores or ulcers that donât heal
unusual changes in your testicles changes in shape, consistency or lumpiness
coughs that donât go away or show blood, a hoarseness that persists
weight loss that canât be explained
moles that have changed shape, size or colour, or bleed, or an inflamed skin sore that hasnât healed
blood in a bowel motion
persistent changes in toilet habits
urinary problems or changes.

These symptoms are often related to more common, less serious health problems. However, if you notice any unusual changes, or these symptoms persist, visit your doctor.

What Questions Should I Ask My Healthcare Provider

If you have prostate cancer, you may want to ask your healthcare provider:

Why did I get prostate cancer?
What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
Has the cancer spread outside of the prostate gland?
What is the best treatment for the stage of prostate cancer I have?
If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
What are the treatment risks and side effects?
Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
Am I at risk for other types of cancer?
What type of follow-up care do I need after treatment?
Should I look out for signs of complications?

A note from Cleveland Clinic

Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.

How Should I Prepare For The Exam

Your blood must be sent to a laboratory for analysis, so your PSA results wont be available immediately. Your doctor will let you know when they have the results.

The lab report will show the level of PSA in your blood as:

In addition to looking at the amount of PSA in your blood, your doctor will assess how quickly this number is changing. Many things can affect PSA, so test results require careful analysis by an expert. Your doctor will take all of your health information into account.

If you have an abnormal PSA test result, it doesnt mean you have prostate cancer. Most men with a high PSA level dont have prostate cancer. About 25 percent of men who have a biopsy due to a high PSA level have prostate cancer.

Its also possible for men with prostate cancer to have normal DRE and PSA test results.

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Screening For Prostate Cancer In Men With A Family History

Burden

The introduction of PSA-based screening for prostate cancer has substantially altered the epidemiologic data for prostate cancer, greatly increasing the number of men with a diagnosis of prostate cancer and thus also the number of men with a father, brother, or son with a history of prostate cancer.

Available Evidence

It is generally accepted that men with a family history of prostate cancer are more likely to develop prostate cancer. A study of twins in Scandinavia estimated that genetic factors may account for up to 42% of prostate cancer risk.18 An analysis from the Finnish site of the ERSPC trial concluded that men with at least 1 first-degree relative with prostate cancer were 30% more likely to be diagnosed with prostate cancer than men without a family history.19 Men with 3 first-degree relatives with prostate cancer or 2 close relatives on the same side of the family with prostate cancer diagnosed before age 55 years may have an inheritable form of prostate cancer associated with genetic changes passed down from one generation to the next. This type of prostate cancer is thought to account for less than 10% of all prostate cancer cases.20

The USPSTF searched for evidence about the potential benefits and harms of PSA-based screening for prostate cancer in men with a family history of prostate cancer.

Potential Benefits

Potential Harms

Advising Men With a Family History of Prostate Cancer

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Am I At Risk Of Prostate Cancer

In the UK, about 1 in 8 men will be diagnosed with prostate cancer in their lifetime. We dont know exactly what causes prostate cancer but there are some things that may mean you are more likely to get it these are called risk factors.

There are three main risk factors for getting prostate cancer, which are things you cant change. These are:

getting older it mainly affects men aged 50 or over

If you have any of these risk factors or if you have any symptoms, speak to your GP. They can talk to you about your risk, and about the tests that are used to diagnose prostate cancer. You can also get in touch with our Specialist Nurses, who can help you understand your risk of prostate cancer.

What Causes Prostate Cancer

Men’s Health Month: Prostate cancer is the most common cancer in men

Experts arent sure why some cells in the prostate gland become cancerous . Genetics appear to play a role. For example:

Youre two to three times more likely to get prostate cancer if your father, brother or son has the disease.
Inherited mutated breast cancer genes and other gene mutations contribute to a small number of prostate cancers.

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Should I Get Screened For Prostate Cancer

This video helps men understand their prostate cancer screening options.

In 2018, the U.S. Preventive Services Task Force made the following recommendations about prostate cancer screening

Men who are 55 to 69 years old should make individual decisions about being screened for prostate cancer with a prostate specific antigen test.
Before making a decision, men should talk to their doctor about the benefits and harms of screening for prostate cancer, including the benefits and harms of other tests and treatment.
Men who are 70 years old and older should not be screened for prostate cancer routinely.

This recommendation applies to men who

Are at average risk for prostate cancer.
Are at increased risk for prostate cancer.

Expert Panel Recommendations For Advanced Prostate Cancer

ADT is the first-line treatment in hormone-sensitive metastatic prostate cancer. Evaluation of bone mineral status and prevention of osteoporosis are recommended.
In metastatic CRPC, chemotherapy with docetaxel is the standard for fit and vulnerable older men.
The tolerability of the docetaxel 3-weekly regimen has not been specifically studied in frail older men. The place of weekly docetaxel in metastatic CRPC should be further evaluated.
Palliative treatments include palliative surgery, radiopharmaceuticals, RT and medical treatments for pain and symptoms.

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