I’ve been interested in what happens to elderly men and women with cancer for a while now. The answer to 'what happens?' boils down to ‘not enough’, ‘never on time’ and ‘not with any care’. Although cancer is a disease of ageing older people don’t seem to get cancer as far as the wider world is concerned – no one over 75 is ever featured in the newspapers if they get cancer and the research literature has consistently identified the lack of old people in cancer trials as a problem, because there is no volume of good evidence on the best treatments in the population group most likely to get cancer. Single site cancer charities avoid projects and initiatives targeting older people, too.
Have you met the elderly? Very nice people. You may be related to some of them or have ambitions to become one yourself. They don’t really seem to exist outside of your own parents or grandparents, except as a drain on our resources, soaking up our tax pounds as if they never paid any in themselves. ‘We’ are the non-elderly, the ‘normal’, too self absorbed to imagine becoming elderly. But the elderly are so obliging. If elderly men and women get cancer they vanish from public consciousness completely, so preserving the illlusion that cancer only counts if you are of working age.
Cancer Research UK’s website explains: “Prostate cancer risk is strongly related to age: very few cases are registered in men under 50 and around three-quarters of cases occur in men over 65 years. The largest number of cases is diagnosed in those aged 70-74.”
I have a particular interest in prostate cancer. It is common and also very odd. So common that a man aged 80 who hasn’t got it somewhere in his prostate is worthy of comment. However , it’s perfectly possible, and common, for a man to live with it and for it to be inconsequential. ‘Only’ 3-4% of men die of prostate cancer, nowhere near the 60-80 % who have it in their prostates by 80 years of age. However, and here’s where it gets even odder - prostate cancer is also the second most common cancer related cause of death in men in the UK. So it can also be seriously consequential.
It can be screen detected but far too often the screen detects the inconsequential prostate cancers. When used to detect prostate cancers in men without symptoms the PSA test eventually results in 48 men getting treatment they didn’t need, in order to save the life of 1 man who did. It’s a risk/benefit profile which is so poor the PSA test is not good enough for use as a test in a population screening programme. Luckily for their mental wellbeing all ‘unlucky’ 48 believe they are the 1, so the PSA test gets a big thumbs up and a ready-made advocacy group from men diagnosed with prostate cancer as a result of the PSA test. They believe their lives were saved, in spite of the evidence that shows their lives were, quite probably, not the 1 life at risk.
The PSA test has a stranglehold on all popular and most medical discussion about prostate cancer. This inadvertently feeds in more ageism to care and treatment of men who have prostate cancer. Men over 70 or so are unlikely to get a random PSA test. Their prostate cancers are much more likely to be clinically detected – meaning they have gone to their GP with symptoms. If the symptoms are due to prostate cancer the disease is likely to be much further advanced so the experience of prostate cancer in the under 70s and over 70s likely to be qualitatively quite different.
Add to that the fact that research evidence is showing people over 70 are much less likely to get standard cancer care anyway and you will see there are excellent reasons for looking at prostate cancer in older men with a critical eye and low expectations.