Lower Urinary Tract Symptoms in Elderly Men: Considerations for Prostate Cancer Testing - Beyond the Abstract
Despite the frequency of this chief complaint, formal guidelines for work-ups are lacking because the association between LUTS and prostate cancer is tenuous at best, and only appropriately selected elderly patients will derive benefit from evaluation for prostate cancer. The urologist encounters even additional uncertainty when these patients present with PSA levels that are moderately elevated. For these patients, there may be valid suspicion for cancer, but not necessarily cancer that is clinically significant given the patient’s life expectancy and competing risks.
In our review, we present an algorithmic approach to the evaluation of these patients. We maintain a central theme that urologists should prioritize clinically significant prostate cancer to spare patients from overdiagnosis. We recognize that the idea of “clinical significance” may change as men get older, and we discuss how risk stratification may change in this population. We also highlight the laboratory tests, biomarkers, and imaging modalities that are superior at detecting high grade prostate cancer but not necessarily validated in older populations.
We hope that this paper provides a helpful framework that encourages a careful, intentional approach to appropriately evaluate these patients.
Written by: Stephen Schmit, MD, Department of Urology, Loyola University Medical Center, Hines, Illinois
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