HEALTHY LIVING
Prostate Cancer After Age 70
Studies show treatments may be more dangerous than living with the disease. :: BY CHRIS ILIADES, M.D.
M
ost men survive prostate cancer, yet it is the second leading cause of cancer death
in American men, behind only lung cancer. “Prostate cancer is very common
but most often grows slowly,” explains Michael Herman, M.D., director of urology at Mount Sinai South Nassau in Oceanside, New York. “There is a saying that many
men die with prostate cancer rather than die from it. Still, it causes about 34,000 deaths each year, making it a leading cancer killer.” Prostate cancer has no symptoms
in its early stages, so screening is important. Since 1986, a blood test that
measures prostate-specific antigen (PSA), a protein that rises during prostate cancer, has been the screening standard. “PSA is a good screening test,
but doing biopsies on everyone with an elevated PSA would lead to overdiagnosis and overtreatment, especially since the harms of treatment can outweigh the benefits for patients who have low-risk disease,” says Herman. When former President Joe
Biden, at age 82, was diagnosed with stage 4 prostate cancer, many people asked how prostate cancer could be missed in a man with the best healthcare possible. The answer is that the doctors
were following prostate cancer guidelines, which recommend
88 NEWSMAX MAXLIFE | SEPTEMBER 2025
stopping PSA screening in men 70 and older.
WHY STOP TESTING? Studies show biopsies and treatments for men 70 and older may be more dangerous than living with prostate cancer.
Biopsies have a significant
complication rate, including bleeding, infection, and inability to pass urine. Both radiation and surgery treatments cause high rates of erectile dysfunction and incontinence. Since 98% of men with prostate
cancer are still alive after 10 years, the risks often outweigh the benefits in men who have a limited life expectancy. At 82, Biden was already past
the average life expectancy for an American male, which is about 76. Men should start prostate cancer
screening between the ages of 40 and 55, depending on their risk factors. At age 55 to 69, current guidelines
from the U.S. Preventive Services Task Force (USPSTF) advise optional testing based on a shared discussion between men and their doctors, and men 70 and older should not be routinely screened. “Men who are healthy and active
after age 70 may have a longer life expectancy and may want to continue PSA screening after a discussion of the risks versus benefits with their urologist,” says Herman. “Men who have a chronic disease
like diabetes, stroke, or heart disease are less likely to benefit.” PSA screening is still done for
men 70 and older if they have symptoms of advanced prostate cancer — “unexpected weight loss, bone pain, fatigue, or blood in the urine,” advises Herman.
SHOULD THEY BE TREATED? The decision to treat depends on how advanced or aggressive the cancer is. A slow-growing cancer does not
need to be treated. “We can perform tests that can tell us which prostate cancers are not aggressive and can be watched, which is called active surveillance,” says Herman. For men with advanced disease
like Biden, the five-year survival rate has been about 30%, but that may be changing. New medications, including those
that target prostate cancer gene mutations, are improving survival and it is not unusual for men with advanced disease to survive for 10 years or longer. “Older men should consider a discussion about PSA testing with a urologist. Understanding the risks and benefits based on a person’s age, symptoms, and general health can be tricky,” says Herman. If a man has a high PSA level, additional tests should be done to determine the aggressiveness of the cancer, Herman advises.
SCAN/SKYNESHER/GETTY IMAGES / PSA TEST/ANGELP/GETTY IMAGES
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