Life Expectancy Uncertainties
Commenting on the research in an interview, Kyle Richards, MD, associate professor with the Department of Urology at the University of Wisconsin School of Medicine and Public Health, in Madison, noted that, “while most urology experts agree that we should not screen for prostate cancer in men with less than 5-10 years life expectancy, the challenge is deciding which patients have a more limited life expectancy.”
Tools and calculators are available to try to calculate life expectancy, “but they can be cumbersome and difficult to incorporate into clinical practice,” he added.
Indeed, the difficulty in accurately estimating life expectancy is also a limitation of the study, he noted.
“The challenge with a study like this is it is very difficult to accurately estimate life expectancy,” he said. “It is easy to pick a cut point (i.e. age 70) but it is very difficult to calculate one’s life expectancy from survey data alone.”
Another limitation is that “screening PSA testing implies that the patient is not having any symptoms, and we do not know from this study if any of these men were getting PSA checks due to some urinary symptoms or other issues,” Dr. Richards added.
“So, while the study does raise some concern about screening PSA in older men, the data source makes it quite difficult to home in on this question.”
When it can be estimated, life expectancy can indeed provide a more useful guide in assessing the options if a patient is found to have prostate cancer, Dr. Richards noted.
“If a patient has a 5- to 10-year life expectancy, and they are diagnosed with a clinically significant prostate cancer, they absolutely may still benefit from treatment,” he said.
“If they have a clinically significant prostate cancer that is unrecognized, it could metastasize and cause symptoms or lead to death, as roughly 30,000 men die from prostate cancer each year in the USA.”
However, “if a patient has a limited life expectancy of less than 5 to 10 years, don’t screen for prostate cancer,” he advised. Proper guidance should furthermore be made loud and clear in guideline recommendations.
“I do think the USPSTF and AUA need to be the primary voices educating primary care and patients regarding prostate cancer screening,” Dr. Richards said.
“We need to be smart about whom to screen, when to screen, and how often to screen. And this message needs to be heard by the primary care providers that perform the screening.”
The study was supported by the Sandra and Edward Meyer Cancer Center and a grant from the National Cancer Institute of the National Institutes of Health.
Dr. Kensler and Dr. Richards had no disclosures to report.