Screening may be considered in men ages 55 to 69 with the knowledge that it will prevent about one cancer death for every 1,000 men screened. Expert guidelines don't recommend PSA screening in men 70 and older.
The USPSTF does not recommend screening for prostate cancer in men, including men with a family history of prostate cancer, older than 70 years.
Prostate biopsies in elderly men are justified only among those aged 76-79 with PSA levels below 20 and minor comorbidities, “as this is the group of patients who could benefit from radical treatment.”
A prostate-specific antigen (PSA) level above 4 ng/mL has historically been recognized as an appropriate threshold to recommend biopsy; however the risk of high-grade disease observed among men with lower PSA levels in the Prostate Cancer Prevention Trial has led to calls to change the criteria for biopsy referral.
Prostate biopsy risks
Infection: The most serious risk of a prostate biopsy is the risk of infection, including urinary tract infections and, less commonly, sepsis.
PSA levels under 4 ng/ml are generally considered normal, while levels over 4 ng/ml are considered abnormal. PSA levels between 4 and 10 ng/ml indicate a risk of prostate cancer higher than normal. When the PSA level is above 10 ng/ml, risk of prostate cancer is much higher.
Called a transperineal biopsy, the procedure is combined with 3D MRI fusion guided technology to highlight prostate cancer. It is the latest urological cancer diagnostic tool to be added to an extensive list of innovative resources used for diagnosing cancer at UC San Diego Health.
The majority of people with prostate cancer — nearly 80% — are diagnosed early and cured by their treatment, most often radiation or surgery. But one in five of those diagnosed with prostate cancer has a more aggressive form of the disease.
3.5-4.5: Normal for a man 60-70 yrs. 4.5-5.5: Normal for a man 70-80 yrs.
Expert guidelines don't recommend PSA screening in men 70 and older. Because of their more limited lifespan, these men are less likely to benefit from early detection of low-risk cancer. One reason is that there may be simply less time for the condition to become life threatening in most men.
Many guidelines recommend against PSA screening in men older than 70 to 75 years because of the risk of over diagnosis and lack of evidence of a mortality reduction in this age group. It's believed that the harms of screening might outweigh the benefits in an older population.
The task force recommends that men ages 55 to 69 make a shared decision with their doctors regarding routine prostate cancer screening, which usually means periodic blood tests for prostate-specific antigen (PSA). The task force advises men to stop screening once they reach age 70.
Life Expectancy and Localized Prostate Cancer
They compared men who had been treated with prostatectomy, radiotherapy and watchful waiting and found that at five years from diagnosis, the type of treatment made little difference to survival.
Life Expectancy After Prostate Cancer Radiation
Those treated with external-beam radiation therapy have a cure rate of 91.3% for high-risk prostate cancer and 95.5% for intermediate-risk prostate cancer. Additionally, the five-year survival rate of this treatment is 98.8% overall.
However, it is a painful procedure since multiple punctures are made with thick (16-18 gauge) biopsy needles to obtain adequate samples of the prostate. The pain associated with the procedure remains largely ignored in clinical practice.
Most men do not find prostate biopsy excessively painful or uncomfortable, and the complications are usually not serious—but can be. Certain steps taken before, during, and after the procedure can improve the outcome: Take antibiotics.
Besides cancer, other conditions that can raise PSA levels include an enlarged prostate (also known as benign prostatic hyperplasia or BPH ) and an inflamed or infected prostate (prostatitis). Also, PSA levels normally increase with age.
Any prostate stimulation can trigger the release of extra PSA. This can include ejaculation and vigorous exercise, especially bike riding – but even having a DRE can raise PSA levels. For this reason, doctors usually draw blood before performing the DRE to avoid affecting the PSA test results.
Prostate cancer is the main cause of an elevated PSA level. But PSA levels increase with age and can reflect different prostate conditions. Other factors that may raise a person's PSA level include: Prostate enlargement and inflammation (prostatitis).