What is the risk of developing prostate cancer at the age of 66?

From the Guidelines

The risk of developing prostate cancer at age 66 is approximately 1 in 6, with a lifetime risk of about 11-12%. For a 66-year-old man, the risk of developing prostate cancer is significant, with more than 60% of all prostate cancers diagnosed in men over 65 1. Other factors that can influence this risk include:

• Family history (having a father or brother with prostate cancer doubles the risk)
• Race (African American men have a higher risk)
• Genetic factors like BRCA1/2 mutations Regular screening through PSA (prostate-specific antigen) blood tests and digital rectal exams is typically recommended for men in this age group, though screening decisions should be individualized based on overall health status and life expectancy 1. Men should discuss with their healthcare provider whether prostate cancer screening is appropriate for their specific situation. The American College of Physicians recommends that clinicians inform men between the age of 50 and 69 years about the limited potential benefits and substantial harms of screening for prostate cancer, and base the decision to screen on the risk for prostate cancer, a discussion of the benefits and harms of screening, the patient's general health and life expectancy, and patient preferences 1.

Some key points to consider when discussing prostate cancer screening with a healthcare provider include:

• The benefits of screening, including the potential to reduce prostate cancer mortality
• The harms of screening, including false-positive results, overdiagnosis, and overtreatment
• The patient's individual risk factors for prostate cancer, including family history and race
• The patient's overall health status and life expectancy
• The potential impact of screening on quality of life, including the risk of anxiety and discomfort associated with screening and treatment.

It is essential to weigh the benefits and harms of screening and make an informed decision based on individual circumstances 1.

From the FDA Drug Label

1. 2 Increased Risk of High-grade Prostate Cancer In men aged 50 to 75 years with a prior negative biopsy for prostate cancer and a baseline PSA between 2.5 ng/mL and 10. 0 ng/mL taking dutasteride in the 4-year Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, there was an increased incidence of Gleason score 8 to 10 prostate cancer compared with men taking placebo (dutasteride 1% versus placebo 0.5%)

The chance to develop prostate cancer at 66 is not directly stated in the label. However, the label mentions that in a 4-year trial, 1% of men taking dutasteride developed high-grade prostate cancer, compared to 0.5% of men taking placebo. No conclusion can be drawn about the specific risk at age 66, as the label does not provide this information 2.

From the Research

Prostate Cancer Risk at 66

• The risk of developing prostate cancer increases with age, but the exact chance of developing prostate cancer at 66 is not directly stated in the provided studies 3, 4, 5, 6, 7.
• However, the studies suggest that the risk of prostate cancer can be assessed using screening tests such as digital rectal examination (DRE) and prostate-specific antigen (PSA) testing 3, 4, 5, 6, 7.
• A study from 2003 found that the overall detection rate of prostate carcinoma was 1.8% based on a positive biopsy, and 83.4% of the detected cancers were localized 6.
• Another study from 2000 found that PSA alone allowed for the detection of 90.5% and 90.0% of cancers at first and follow-up visits, respectively, compared to 41.1% and 25.0% by DRE alone 5.
• The sensitivity, specificity, and positive predictive value of PSA and DRE as screening tests for prostate cancer have been reported in various studies, with PSA generally showing higher sensitivity and specificity than DRE 4, 6.

Screening Tests for Prostate Cancer

• DRE and PSA testing are commonly used screening tests for prostate cancer, but their effectiveness and usefulness are still being studied and debated 3, 4, 5, 6, 7.
• A 2024 study found that the positive predictive value of DRE was similar to that of PSA, but the cancer detection rate of DRE was significantly lower than that of PSA 4.
• A 2007 study found that finasteride improved the sensitivity of DRE for prostate cancer detection, particularly for higher-grade tumors 7.
• The studies suggest that PSA testing may be more effective than DRE in detecting prostate cancer, especially in asymptomatic men 5, 6.