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University of Iowa News Release

March 22, 2005

UI Studying Prostate Cancer Screening In Elderly Men

A study led by University of Iowa clinicians seeks to develop recommendations for prostate cancer screening and management in elderly men -- age 75 and older -- in Iowa. The results have the potential to make an impact nationwide.

Most men are not usually screened for prostate cancer after age 75 because typically they will die of something else within 10 years even if they have prostate cancer.

Generally, men are screened beginning at age 50. Men with risk factors -- those who are African-American and/or have a family history of the disease -- should be screened beginning at age 40. However, there are no guidelines about when to stop screening, said the study's director, Badrinath Konety, M.D., assistant professor of urology in the UI Roy J. and Lucille A. Carver College of Medicine and a urologist with UI Hospitals and Clinics.

"We want to see if you can use a more tailored approach to screening for prostate cancer in men age 75 and older and establish guidelines about how they need to be treated," Konety said. "Death rates from prostate cancer have improved for every age group except for those men over age 85. It seems we need to do more to help these elderly men."

The collaborative study involves the Iowa Department of Public Health, t, the Iowa Consortium for Comprehensive Cancer Control, the UI Department of Urology and Holden Comprehensive Cancer Center at the UI. The effort is funded by the Centers for Disease Control. Victoria Sharp, M.D., associate professor (clinical) of urology, is the study's co-director. 

The team is surveying physicians statewide and will hold a conference for primary care providers and sub-specialists on "Prostate Cancer Screening and Management in Elderly Men in Iowa" April 29 in Des Moines. Physicians may contact the UI Continuing Medical Education Division at 319-335-8599 or visit online at www.medicine.uiowa.edu/cme/conferences for more information.

Studying prostate cancer screening for older men is an important public health concern, given that Iowa has the second highest proportion of men age 85 and older in the county, and there are more than 6.5 million men age 75 and older nationwide.

"For example, the screening approach could also be individualized based on a patient's health and vigor," Konety said. "If a patient older than 75 years has symptoms which could be attributable to prostate cancer, it may be wise to check for the disease as the person could have had the disease for a while, and you want to treat the symptoms such as pain."

The prostate is a gland in males that is located between the bladder and rectum. Normally the size of a walnut, it produces prostate-specific antigen (PSA), which has the main purpose of liquifying the semen.

Screening is somewhat controversial as the U.S. Preventive Services Task Force says there is insufficient evidence to demonstrate that routine screening saves lives, while the American Cancer Society and the American Urologic Association both encourage routine testing. However, doctors are finding the disease earlier, when it is localized to the prostate and, therefore, is more curable, so many doctors use the screening approaches.

A PSA test value of 4 or higher indicates a possible problem with the prostate. However, only one in four men with a PSA between 4 and 10 has prostate cancer, Konety said.

Also, some men do not have a high PSA even though they may have prostate cancer. However, a digital rectal exam (DRE) may allow a doctor to detect a lump or nodule that indicates an abnormality.

"When used in combination, the PSA and DRE tests identify about two out of three prostate cancers," Konety said.

The Holden Comprehensive Cancer Center is Iowa's only National Cancer Institute (NCI)-designated comprehensive cancer center. NCI-designated comprehensive cancer centers are recognized as the leaders in developing new approaches to cancer prevention and cancer care, conducting leading edge research and educating the public about cancer. Visit the center online at www.uihealthcare.com/depts/cancercenter/.

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at www.uihealthcare.com.

STORY SOURCE: University of Iowa Health Science Relations, 5137 Westlawn, Iowa City, Iowa 52242-1178

PROGRAM CONTACT (for Physicians): UI Continuing Medical Education Division, 319-335-8599, www.medicine.uiowa.edu/cme/conferences

MEDIA CONTACT: Becky Soglin, 319 335-6660 becky-soglin@uiowa.edu