Lower urinary tract symptoms in elderly men: Considerations for prostate cancer testing

• Published in: The Prostate Vol. 84; no. 14; pp. 1290 - 1300
• Main Authors: Schmit, Stephen, Malshy, Kamil, Ochsner, Anna, Golijanin, Borivoj, Tucci, Christopher, Braunagel, Taylor, Golijanin, Dragan, Pareek, Gyan, Hyams, Elias
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.10.2024
• Subjects: Decision making; Epidemiology; Literature reviews; lower urinary tract symptoms; Older people; Prostate cancer; prostate‐specific antigen; prostatic neoplasms; Urinary tract; Urogenital system; prostate cancer; prostate‐specific antigen; lower urinary tract symptoms; prostatic neoplasms
• ISSN: 0270-4137; 1097-0045; 1097-0045
• DOI: 10.1002/pros.24772

Purpose Both lower urinary tract symptoms (LUTS) and prostate cancer (PCa) are common in elderly men. While LUTS are generally due to a benign etiology, they may provoke an evaluation with prostate‐specific antigen (PSA), which can lead to a cascade of further testing and possible overdiagnosis in patients with competing risks. There is limited patient and provider understanding of the relationship between LUTS and PCa risk, and a lack of clarity in how to evaluate these men to balance appropriate diagnosis of aggressive PCa with avoidance of overdiagnosis. Methods A literature review was performed using keywords to query the electronic database PubMed. All articles published before November 2023 were screened by title and for articles relevant to our subject. Results Epidemiological studies suggest that LUTS and PCa are largely independent in elderly men. The best available tools to assess PCa risk include PSA permutations, novel biomarkers, and imaging, but there are limitations in older men based on lack of validation in the elderly and unclear applicability of traditional definitions of “clinically significant” disease. We present a three‐tiered approach to evaluating these patients. Conclusion Elderly men commonly have LUTS as well as a high likelihood of indolent PCa. A systematic and shared decision‐making‐based approach can help to balance objectives of appropriate detection of phenotypically dangerous disease and avoidance of over‐testing and overdiagnosis.