Screening for prostate cancer in long-term care

Prostate cancer is a common disease and is the second leading cause of cancer-related death in men. However, many older men with prostate cancer will die from comorbid illness rather than cancer. Survival from prostate cancer with available treatment options, including surgery, radiation, androgen suppression, and watchful waiting, is mediated by age, tumor grade, and comorbid illness. Due to the long natural history of prostate cancer and the presence of competing comorbidities, the majority of elderly men with newly diagnosed prostate cancer will not benefit from curative therapy. Even more relevant to the long-term care population is the further lack of benefit from diagnosing early-stage prostate cancer in men with advanced age, multiple comorbidities, and a high prevalence of dementia. Thus, in the longterm care population, a rational approach to the detection of prost ate cancer is to evaluate suspected symptomatic or metastatic disease exclusively.