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Evaluation and Treatment for Older Men with Elevated PSA

  • Benjamin H. Press
  • Marc A. Bjurlin
  • Samir S. Taneja
Chapter

Abstract

The management of elderly men presenting with asymptomatic, elevated PSA levels requires careful consideration of the risks and benefits of biopsy, cancer detection, and subsequent cancer treatment. In men over the age of 75 years, presenting with elevated PSA levels, the prevalence of prostate cancer is high, but the benefit of treatment is not clear. The risk of prostate cancer mortality declines as men age and competing risks of mortality grow. As such, careful consideration of patient health and longevity is the mainstay of decision-making in this clinical scenario. If healthy, further evaluation with prostate MRI, predictive nomograms, and/or selective biomarkers may allow selection of men at greatest risk harboring cancers which potentially affect natural longevity. In this manner, not all men presenting at age 76 with modestly elevated PSA will require biopsy, but those few who remain at risk of prostate cancer mortality might still benefit from early detection.

Keywords

Elevated PSA Prostate PSA results Elderly men and the PSA PSA screening Screening with the PSA USPSTF statement on PSA-based screening 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Benjamin H. Press
    • 1
  • Marc A. Bjurlin
    • 2
  • Samir S. Taneja
    • 3
  1. 1.Rutgers—New Jersey Medical SchoolNewarkUSA
  2. 2.Department of UrologyNYU Langone Hospital—BrooklynBrooklynUSA
  3. 3.Division of Urologic Oncology, Department of UrologyNYU Langone HealthNew YorkUSA

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