Grant Number:	1R01CA307253-01A1 Interpret this number
Primary Investigator:	Kensler, Kevin
Organization:	Weill Medical Coll Of Cornell Univ
Project Title:	Optimizing Prostate Cancer Screening Among Older Men
Fiscal Year:	2026

PROJECT ABSTRACT/SUMMARY Two-thirds of men aged ≥70 years in the United States have multiple chronic medical conditions, and heart disease and cancer, particularly lung and colorectal, are the two leading causes of death. Prostate cancer only accounts for 1.3% of deaths in this age cohort. While prostate cancer incidence is high among men ≥70, most men diagnosed with prostate cancer will die from other causes. Although screening for prostate cancer using prostate-specific antigen (PSA) has demonstrated some clinical benefit in younger men, for men ≥70 the benefits remain unclear. High quality evidence demonstrating prostate cancer screening extends the lifespan is lacking among older men, but screening has been more conclusively linked to overdiagnosis, overtreatment, and complications in the diagnostic work-up. Given uncertain benefits and harms, clinical guidelines call for shared decision-making regarding prostate cancer screening, with routine screening not recommended for men ages ≥70 or those with less than 10-year life expectancy. Despite these recommendations, use of PSA- based screening remains high among older men even though then men may be less likely to benefit due to comorbid health conditions. Decision-making regarding prostate cancer screening continuation/discontinuation among older men should consider patient age, PSA levels, prostate cancer risk, life expectancy, and general health, as well as patient preferences and values, but it is not clear how these factors are weighed in practice, nor how they should be weighed to optimize screening outcomes for older men. To address these gaps, we will use a mixed methods approach to understand how prostate cancer screening cessation should be tailored to patient health status among older men. We will identify key factors that influence current patient and physician decision-making regarding prostate cancer screening among older men through semi-structured interviews. Using linked electronic health record, tumor registry, mortality records, and insurance claims data from TriNetX, we will apply novel target trial emulation methods to generate needed evidence to inform clinical guidelines regarding the benefits and harms of continued prostate cancer screening among older men. Finally, using recurring neural networks, we develop and validate an electronic health record-integratable risk prediction tool to provide personalized estimates of the likelihood of developing aggressive prostate cancer for older men, tailored to their health status. Findings from these projects will address evidence gaps regarding benefits and harms of prostate cancer screening for older men and develop tools that may offer decisional support for patients and healthcare providers. Widespread implementation of personalized approaches to prostate cancer screening continuation/discontinuation can lead to reductions in overdiagnosis and overtreatment of prostate cancer for older men for whom prostate cancer may be just one of several health concerns, while retaining benefits of early detection on survival among older men at higher risk of prostate cancer mortality.





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