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| source : lifecarehospital.ae |
Let me start with a confession: I never used to think much about prostate cancer, it always felt like something distant, something that happened later. But after watching a close family member go through the diagnostic and treatment maze in his early 70s, I realized how murky (and outdated) some of the guidance out there is, especially for older men. So I did what I do best: read everything I could get my hands on, listened to expert interviews, and even spoke with a few physicians to better understand what men over 70 should know if they’re facing metastatic prostate cancer.
Here’s a breakdown, in plain, human language, of what’s going on with screening, diagnosis, and treatment if you're in this age group.
Why PSA Screening Isn’t Standard for Men Over 70 (But Still Happens)
The US Preventive Services Task Force (USPSTF) doesn’t recommend routine PSA (prostate-specific antigen) screening for men over 70. Why? Because prostate cancer often grows slowly, and many older men die with the disease rather than from it.
The concern is that aggressive treatment could cause more harm than good, things like incontinence, sexual dysfunction, or even heart problems. That said, many physicians still do offer PSA testing for men over 70, especially if the man is healthy, active, and has a longer life expectancy.
As Dr. Marc Garnick from Harvard Medical School puts it: many cases of metastatic prostate cancer in older men are only discovered after symptoms show up, which may include:
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Trouble urinating
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Bone pain
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Fatigue
That’s a reactive way to discover a serious issue. So, depending on your health status and personal values, PSA screening might still be a conversation worth having with your doctor.
What Happens If a PSA Test Is Elevated?
If your PSA is high, doctors may recommend:
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Prostate needle biopsy (still the gold standard for confirming cancer)
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Digital Rectal Exam (DRE) to feel for abnormalities
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MRI scans to guide more precise biopsies
The diagnosis process has improved significantly in recent years, MRI-guided biopsies, for example, can reduce false positives and missed tumors.
Understanding the Risk: Gleason Scores and Genetic Clues
Once cancer is confirmed, a Gleason score is assigned based on how aggressive the cells look under a microscope. Today, that system is simplified into Grade Groups 1–5, where:
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Grade Group 1 = low risk
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Grade Group 5 = high risk
Doctors may also recommend genetic testing, especially for BRCA1 or BRCA2 mutations, which are linked to more aggressive forms of the disease. Knowing your genetic status can also help family members understand their own risks for other cancers, like breast or ovarian cancer.
So... How Do You Know If It’s Metastatic?
Metastatic prostate cancer means the disease has spread beyond the prostate, often to bones or lymph nodes. The tools to detect this have improved too:
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CT scans and bone scans were the old standard
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Today’s preferred method? PSMA PET scans, which track a protein called prostate-specific membrane antigen that lights up in cancerous tissue, even tiny tumors.
Based on the scan, doctors classify the cancer as:
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Oligometastatic: 3–5 small metastases
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High-volume: More widespread
Treatment Options: Tailored, Layered, and Evolving
Back in the day, metastatic prostate cancer had a grim outlook. Today, the treatment approach is more hopeful and strategic, especially for men in good health.
Here’s what doctors may offer:
Doublet Therapy
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A hormone-blocking shot (like Lupron) to suppress testosterone
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A second drug that blocks testosterone from fueling the cancer (e.g., Xtandi, Nubeqa, Zytiga)
Triplet Therapy
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Add chemotherapy on top of doublet therapy if the cancer is more aggressive or spreading
Radioligand Therapy
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If the cancer expresses a high amount of PSMA, a treatment like Lutetium-177 targets and delivers radiation directly to cancer cells
Metastasis-Directed Therapy (MDT)
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For oligometastatic cases, doctors may zap the few cancer spots with focused radiation
Targeted Therapy
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Men with BRCA mutations may benefit from PARP inhibitors like Lynparza or Rubraca
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Other mutations (e.g., MSI-high) may respond to immunotherapy drugs like Keytruda
One Crucial (but Overlooked) Step Before Starting Treatment
Hormone therapy, especially over time, can increase the risk of heart issues. That’s why many experts recommend getting a cardiac checkup before starting treatment. If you’re over 70, odds are you already have some degree of cardiovascular risk. Don’t skip this.
The Outlook? Better Than You Might Think
Ten years ago, a metastatic diagnosis often felt like a death sentence. Now, thanks to more personalized therapies, better imaging, and smarter diagnostics, many men live 10 years or more post-diagnosis, especially if treatment starts early and is well-managed.
We're even seeing doctors treat the primary prostate tumor again, with radiation, even in metastatic patients, something unheard of not long ago.
Final Takeaway
If you or someone you love is over 70 and navigating prostate cancer, here’s what I’ve learned:
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Don’t let age alone determine your options
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Push for clear conversations about risks, imaging, and treatment
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Don’t hesitate to get second opinions or genetic testing
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And absolutely, positively, keep heart health in mind
As always, your journey will be unique, but it doesn’t have to be confusing. Armed with good questions and the right information, you can navigate this well.