Lazzaro Repetto, MD; Angela Marie Abbatecola, MD, PhD; Giuseppe Paolisso, MD
Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0898.
Requests for Single Reprints: Lazzaro Repetto, MD, Sanremo Hospital, Department of
Oncology, Via G Borea, 56, 18038 Sanremo (IM), Italy.
Current Author Addresses: Dr. Repetto: Sanremo Hospital, Department of Oncology, Via G
Borea, 56, 18038 Sanremo (IM), Italy.
Dr. Abbatecola: Italian National Research Center on Aging, Scientific Direction, Via Santa Margherita,
5, 60100 Ancona, Italy.
Dr. Paolisso: Second University of Naples, Department of Medical, Surgical, Neurological, Metabolic
and Geriatric Sciences, Piazza Miraglia, 2, 80138 Naples, Italy.
Repetto L., Abbatecola A., Paolisso G.; “The Older, the Wiser” in Prostate Cancer Treatment Choices?. Ann Intern Med. 2013;158:772-773. doi: 10.7326/0003-4819-158-10-201305210-00013
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Published: Ann Intern Med. 2013;158(10):772-773.
Prostate cancer has rapidly surpassed lung cancer to become the most common form of cancer in men. The
widespread use of the serum prostate-specific antigen (PSA) level for early detection may partially explain
this change. In 2012, Siegel and colleagues (1) projected
241 740 new cases of prostate cancer—representing approximately 30% of new cancer diagnoses in
men—and 28 170 deaths from the disease. They also estimated the probability of prostate cancer
across age groups and found that it jumped from 2.63% (1 in 38) in men aged 40 to 59 years to 6.84% (1 in
15) in those aged 60 to 69 years and 12.54% (1 in 8) in those aged 70 years or older. Unfortunately,
diagnosis in patients aged 70 years or older often compels physicians to offer and patients to request
treatments that do not translate into better quality of life and survival. Such professional organizations
as the American Cancer Society and the American Urological Association currently recommend annual screening
with the PSA test beginning at age 40 years for men at high risk for prostate cancer and at age 50 years for
those at average risk (2–4). However, the U.S.
Preventive Services Task Force has stated that the balance between the benefits and harms of screening men
younger than 75 years is unknown and that PSA-based screening in men older than 75 years is more likely to
be harmful than beneficial (5).
Andrew M.D. Wolf, MD
University of Virginia School of Medicine
May 21, 2013
Conflict of Interest:
I don't consider this a conflict but in the interest of full disclosure, I was first author of the American Cancer Society prostate cancer screening guideline published in 2010.
Correction to editorial
Please note that the statements regarding current guidelines are incorrect. The American Cancer Society does not recommend screening. It recommends that men be engaged in a shared decision making process regarding whether they wish to be screened beginning at age 50 for men at average risk, age 45 for men at increased risk (African American or family history of first-degree relative), and age 40 if extremely high risk (e.g., multiple first degree family members with prostate cancer). It recommends against screening at ANY age for men whose life expectancy is under 10 years. The article accompanying this editorial lends indirect support to this latter aspect of the guideline. The U.S. Preventive Services Task Force explicitly recommends against screening for prostate cancer at ANY age for average risk men (D recommendation); the insufficient evidence (or I) recommendation was replaced with a D recommendation last year.
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Hematology/Oncology, Prostate Cancer.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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