Understanding metastatic prostate cancer in men over 70: Know how to detect and modern treatment options that can extend life |

Screening for prostate cancer becomes more complex in men over the age of 70. The US Preventive Services Task Force (USPSTF) currently recommends against routine PSA testing in this age group. The PSA test measures the level of prostate-specific antigen in the blood, which can be a sign of prostate cancer.The main reason for this recommendation is that prostate cancer often grows very slowly. Many older men are more likely to live with the disease rather than die from it. Treatments can also cause side effects such as urinary problems, fatigue, or sexual difficulties. According to the USPSTF, these harms may outweigh the benefits of detecting the disease early in older men.

However, as men today are living longer and healthier lives, some experts believe these guidelines need updating. The last update was in 2018, and new recommendations are expected soon.

Metastatic prostate cancer is prostate cancer that has spread beyond the prostate gland to other parts of the body. Prostate cancer usually begins in the prostate, a small gland in men that produces seminal fluid. In its early stages, the cancer is generally confined to the prostate and often grows slowly.When the cancer becomes metastatic, it spreads to other areas of the body through the blood or lymphatic system. The most common sites for metastasis are the bones, lymph nodes, and sometimes the lungs or liver.Metastatic prostate cancer is more serious than localised cancer because it can affect other organs and cause symptoms such as bone pain, fatigue, urinary problems, and weight loss. Treatment usually focuses on slowing the cancer’s growth, managing symptoms, and extending life, rather than curing the disease, although recent advances in therapy are improving outcomes significantly.

Although it is not routine, some men over 70 still have PSA tests. This usually happens after discussing the pros and cons with their doctor. Often, testing is done when symptoms appear, such as trouble urinating, tiredness, or bone pain.Dr Marc B. Garnick, Professor of Medicine at Harvard Medical School, explains that it is not uncommon to find advanced prostate cancer in older men through these tests. In many cases, the disease has already spread by the time symptoms appear. This highlights the importance of making screening decisions individually, based on a man’s overall health and life expectancy.

If a PSA test suggests that cancer may be present, the next step is usually a prostate needle biopsy. This involves taking small samples of prostate tissue to check for cancer cells. Doctors also perform a digital rectal examination (DRE) to feel for any lumps or changes in the size or shape of the prostate.Modern imaging technology now plays an important role in diagnosis. Magnetic resonance imaging (MRI) scans can provide clear, detailed pictures of the prostate. This allows doctors to identify suspicious areas more accurately and take targeted biopsy samples. MRI-guided biopsies are becoming a preferred method because they improve accuracy and help avoid unnecessary procedures.

Once prostate cancer is confirmed, doctors study the cancer cells under a microscope to see how aggressive they are. This helps them understand how quickly the cancer may grow and spread.For many years, doctors used the Gleason score to grade prostate cancer. This score ranges from 6 to 10, based on how abnormal the cells look. A score of 6 suggests a slow-growing cancer, while a score of 9 or 10 points to a more dangerous, fast-growing type.A newer system now groups cancers into five Grade Groups. Grade Group 1 represents the least aggressive cancer, while Grade Group 5 represents the most aggressive form. This simpler system helps patients better understand their diagnosis.Doctors can also order genetic tests to look for inherited mutations, such as BRCA1 or BRCA2. Men with these mutations are more likely to develop aggressive prostate cancer. These genes are also linked to breast and ovarian cancers, so results can have important implications for family members.

To find out if prostate cancer has spread, doctors use imaging scans. In the past, CT scans and bone scans were commonly used to check the lymph nodes and bones. Today, more advanced tests like the PSMA scan are used.A PSMA (prostate-specific membrane antigen) scan is more sensitive and can find very small clusters of cancer cells that other scans may miss. This test looks for a protein that appears in large amounts on the surface of prostate cancer cells.Based on scan results, doctors classify the cancer as high-volume or low-volume metastatic disease, depending on how much it has spread. If only a few small areas of cancer are found, it is described as oligometastatic prostate cancer, which often responds better to treatment.

Treating metastatic prostate cancer usually involves combining several therapies to stop the cancer from growing and spreading.The main approach is known as doublet therapy, which uses two different drugs that reduce or block testosterone. Testosterone is a hormone that prostate cancer cells need to grow.As reported by Harvard Health, the first drug, leuprolide (Lupron), stops the body from making testosterone. The second drug comes from a group known as androgen receptor pathway inhibitors (ARPIs). These medicines, such as enzalutamide (Xtandi), darolutamide (Nubeqa), apalutamide (Erleada), or abiraterone (Zytiga), block testosterone from attaching to cancer cells.If the disease continues to spread, doctors may add chemotherapy to create a stronger treatment known as triplet therapy. This approach combines hormonal and chemotherapy drugs to fight cancer on multiple fronts. Some men begin triplet therapy right away if their cancer is widespread.

In the past, metastatic prostate cancer was seen as a fatal condition. However, major progress in diagnosis and treatment has changed that outlook. Today, many men live 10 years or longer with the disease.Doctors are also finding benefits in treating the prostate gland itself, even after cancer has spread. Radiating the prostate can slow disease progression and improve survival, which was not considered a standard option in the past.These advances have turned metastatic prostate cancer into a more manageable long-term condition rather than an immediate life-threatening illness. Before starting hormone-based treatments, doctors recommend a heart and cardiovascular evaluation. Hormonal therapies can increase the risk of heart problems, so it is important to monitor blood pressure, cholesterol, and overall heart health during treatment.Managing these risks through regular check-ups, diet, and exercise can help patients stay healthier throughout their cancer therapy.Also Read | Lung cancer symptoms on fingers: Finger clubbing, nail changes and other warning signs that could indicate serious health risks