1270 Elevated PSA in Elderly Men

Abstract

Abstract Introduction Elevated PSA is a common urological cancer pathway referral. Investigating older men can result in overdiagnosis and overtreatment. Routine screening for prostate cancer is not recommended. Current NICE guidelines advice referring PSAs > 3 in 50-69-years, but no guidelines exist for elderly patients (>80-years). Aim 1)To identity the number of elderly men investigated under the 2WW pathway for elevated PSA. 2) Review of outcomes of newly diagnosed prostate-cancer in the elderly with PSA <20ng/ml. Method Retrospective data between Jan 2020-July 2021 identified 108 patients ≥ 80-years referred with elevated PSA: 38% with PSA ≤10ng/ml (n = 60), 32% with PSA 10ng-19/ml (n = 51). Patients were classified according to age-group; 1) 80-85-years, 2) 86-90-years, 3) >90-years. A further sub-group within each age-group according to PSA: 1) PSA 0-10ng/ml and 2) PSA 10-19ng/ml. Results 45% (n = 18) of <85-years (n = 40) with PSA <10ng/ml progressed to investigations with MRI (n = 16), TP-biopsy(n = 12) and bone-scan (n = 9). Within this group 17.5%(n = 7) were treated with hormone and/or radiotherapy. In a similar cohort (n = 32) with PSA 10-19ng/ml 56% (n = 18) were investigated (MRI n = 11, TP-biopsy n = 6, and bone-scan n = 13), of which 15.6% (n = 5) had hormone and/or radiotherapy. Men aged 86-90-years 5.6% (n = 1) and 53.8% (n = 7) had bone-scans only for respective PSA <10ng/ml (n = 18), and 10-19ng/ml(n = 13) group. Men >90-years had no investigations. Men >85-years had no treatment. Conclusions 11% of 80-85 years-old with PSA <20ng/ml received hormone or radiotherapy. Managing elevated PSA in the elderly is a contentious issue, requiring further large-study investigations, and new guidelines to avoid over-diagnosis and investigation.