Men older than 70 years are more likely than younger men to die from prostate cancer (PCa) at any PSA level, according to a new study.

In a study of 230,081 US veterans, of whom 24,142 (10.5%) died from PCa during a 10-year study period, investigators found that 77.4% of PCa deaths occurred among those diagnosed at age 70 to 89 years.

“The current dogma that older men do not need treatment because of their age and comorbid conditions may need to give more weight both to their life expectancy and PSA level before diagnosis rather than age alone,” F. Roy MacKintosh, MD, of VA Sierra Nevada Health Care System in Reno, and colleagues reported online in Frontiers in Oncology.

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They noted, for example, that the average life expectancy for a man aged 75 years in the United States is about 12 years. If diagnosed with PCa at age 75 with a PSA of 10 ng/mL, “our results suggest that his risk of prostate cancer-specific death is likely to exceed 33% at his life expectancy, which may justify aggressive treatment.”

Study results show that higher PSA values prior to diagnosis predict a greater risk of death in all age groups, Dr. MacKintosh and colleagues reported. Within the same PSA range, older age groups are at increased PCa death risk. For example, among those with a PSA level of 7 to 10 ng/mL, the PCa death rate 10 years after diagnosis increased from 7% among those aged 50 to 59 years to 51% for those aged 80 to 89 years. The pattern was consistent across all ranges of PSA at diagnosis.

“Our finding that older men have increased cancer-specific mortality risk across all PSA ranges suggests that older men may be presenting with later-stage cancers, have cancers that behave more aggressively, and/or receive less aggressive treatment than younger men,” the researchers stated.

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