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Advanced Prostate Cancer On the Rise Among Older American Men

A greater number of American men, age 75 and older, are presenting with more advanced cases of prostate cancer at the time of diagnosis. The numbers are up significantly over the past few years, suggesting to some that recent changes in screening protocols may be to blame.

In an effort to reduce over-diagnosis and overtreatment rates, the U.S. Preventative Services Task Force first raised red flags about the use of the prostate-specific antigen blood test for routine screening in 2008. This widely used screen is able to detect protein that is associated with prostate cancer. The problem, however, is that PSA levels may rise due to other causes. In addition, high PSA level results may also be false positives. Since disconcerting PSA tests typically lead to biopsies and other interventions, the task force moved to take this screen off the table in low-risk cases. The idea was to spare men from invasive procedures that may turn out to be unnecessary.

While the task force’s move was more or less cemented by 2012, many healthcare providers have warned that the removal of the PSA from routine screening would likely lead to the diagnosis of more aggressive or advanced forms of prostate cancer.

The recent study appears to support that fear. The study in question involved a review of more than 540,000 prostate cancer cases diagnosed between 2004 and 2013. Researchers found that the number of men under age 75 in that group who were diagnosed with distant metastases only rose from just under 3 percent in 2004 to about 4 percent in 2013. Although that number is not statistically insignificant, the number of men age 75 and up who presented with advanced prostate cancer rose from about 46 percent in 2004 to more than 56 percent in 2013. That increase has some questioning whether the removal of the PSA was the best choice to make.

As controversy continues to surround the use of the PSA, men who are concerned about prostate cancer are urged to talk to their doctors. While the PSA is no longer offered as a standard protocol, this test and others are still available when men or their doctors request its use.