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“The Older, the Wiser” in Prostate Cancer Treatment Choices?

Lazzaro Repetto, MD; Angela Marie Abbatecola, MD, PhD; and Giuseppe Paolisso, MD
[+] Article, Author, and Disclosure Information

From Sanremo Hospital, Sanremo, Italy; Italian National Research Centre on Aging, Ancona, Italy; and Second University of Naples, Naples, Italy.

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.

Ann Intern Med. 2013;158(10):772-773. doi:10.7326/0003-4819-158-10-201305210-00013
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In this issue, Daskivich and colleagues investigated the effect of age, tumor risk, and comorbidity on survival in a large population-based cohort of men older than 60 years with prostate cancer. Their findings suggest that the number of comorbid conditions is effective in predicting mortality across age groups. The editorialists discuss the study and its findings, concluding that consideration of these factors may help to identify certain older men who are unlikely to benefit from aggressive therapy.

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Correction to editorial
Posted on May 21, 2013
Andrew M.D. Wolf, MD
University of Virginia School of Medicine
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.
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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